A Developmentally-Based, Integrated Curriculum in Communication and Interpersonal Skills for Medical Students: Bringing this to your Home Institution Joseph S. Weiner, MD, PhD; Alice Fornari, EdD; Marie Barilla-Labarca, MD; Ruth Ellen Pearlman, MD; Judith Brenner, MD Hofstra North Shore-LIJ School of Medicine Hempstead, NY

Overview Summary of Communication Curriculum at the Hofstra North Shore-LIJ School of Medicine – Communication Training Core Skills Longitudinally refined skills – Faculty development – Assessment Breakout tables will explore these topics in more detail

Hofstra Curriculum Pedagogic Foundations – Values-Based Curriculum Communication is a theme that weaves through all four years

Aligned Values, Principals and Goals Drives Good Outcomes

Hofstra Curriculum Pedagogic Foundations – Three Function Model [Cole and Bird] Function 1: Establish an effective relationship. – Interpersonal skill development Function 2: What is the problem or issue? – Information gathering and synthesis Function 3: Shared education, motivation and treatment planning. – Decision making models – Motivational interviewing – Longitudinal patient care

Hofstra Curriculum Pedagogic Foundations – Skills-Based Training Minimal lecture – Knowledge is not an endpoint – Knowledge facilitates skill development Guided Practice – Role play; Standardized patients; Immediate clinical exposure Communication skills should be immediately applicable to the students’ clinical experiences.

Hofstra Curriculum Pedagogic Foundations – Assessment Multiple domains [Verbal/Written Communication, Self Assessment, Individual and Group Video Review] Skills based assessment [standardized patients, coaching] Formative and Summative Assessment drives learning

Integration Throughout

Skills Relevant to the Student’s Professional Life Intensive introductory course (7 weeks) – Deconstruction of basic, generalizable skills – Developmentally appropriate Focus on function 1 [relationship building] Focus on function 2 [information gathering and synthesis of the problem] Clear demarcation in the curriculum with Function 3 [treatment planning and education] – Verbal and written communication skills

Relevant Skills : MS-1 Developmental Progression Summer MS-1 [First 7 Weeks of Med School] – Core Communication Skills Initial Engagement with a Patient Chief Complaint and HPI Highly Specific Empathy Skills PMH, Medication,…., Social History Practice an Interview with an SP Trust Building Cognitive Exam

Relevant Skills : MS-1 Developmental Progression Fall MS-1 – Communication about screening tests – Obtaining a sexual history – Sharing difficult (“bad”) news Winter MS-1 – Communication with Children/Adolescents: Chronic Illness – Readiness for Change – Screening for Problem Drinking

Relevant Skills : Developmental Progression Winter MS-1 – Intimate Partner Violence: screening for a history of abuse – Screening for problem drinking Spring MS-1 – Motivational Interviewing: Lifestyle Choices – Motivational Interviewing: Smoking Cessation

Faculty Development Recruitment Introduction to skills-based training – Philosophic shift from passive learning Training in “Giving Feedback” Training in Coaching/Role Play

Assessment Interaction with Standardized Patient Aligning the taught skills with assessment Some unfamiliar scenarios to give the student a chance to apply taught skills [formative] Formative assessment Summative assessment

Resources Core Communication Team Faculty (Salaried and Voluntary) Assessment Center – Medical Director – Standardized Patient Trainer – SP Rooms/Video/Data Storage – Standardized Patient Pool Curriculum Time

Core Communication Skills Training Our 7-Week Core Outcomes 1.Initial Engagement with a Patient 2.Chief Complaint and HPI, Part I 3.Chief Complaint and HPI, Part II 4.Highly Specific Empathy Skills 5.Practice an Interview with an SP/Full History 6.Trust Building 7.Cognitive Exam Specific Skills-Based Learning Objectives:  Verbal Communication  Written Communication  Self Assessment  Exposure to Coaching

A Sample Class 1.Goals 2.Learning Objectives 3.Pre-reading 4.Class Plan (Highly Structured) Framing lecture (20 minutes) Large or small group discussion (20 minutes) Skills-based Practice/Role Play (60 minutes) Discussion (10 minutes): – What will you immediately apply? – What are ongoing challenges?

Faculty Development Core Principles

Assessment Drives Learning Weeks devoted to Assessment A representative week

Assessment: Formative and Summative CLINICAL SKILLS EXERCISES FOR ACADEMIC YEAR Competency CourseStation NameMedical KnowledgePatient Care Interpersonal Skills and Communication ProfessionalismFormative or Summative CPR RIA Week Back Pain/ Empathy √√√√Formative Pneumonia/ Building Rapport √√√√Formative Prenatal Visit/ Building Rapport √√√√Formative Longitudinal SP: Abdominal Pain √√√√Formative BI RIA Week Recurrent CHF/ Health Care Proxy √√√√Formative HIV Testing/ Social History √√√√Formative Genetic Screening/ Delivering Difficult News √√√√Formative Longitudinal SP: Chest Pain √√√√Formative FTB RIA Week DM/ Lifestyle Assessment √√√√Formative Postnatal Visit/ Empathy and Non- Verbal Communication √√√√Formative Longitudinal SP: Blood in Stool √√√√Formative HOM RIA Week Gout/ Seven Characteristics of a Symptom √√√√ Summative/ Comprehensive Vaccines/ Cultural Competency/ Curiosity, Empathy and Respect √√√√ Summative/ Comprehensive Excessive Thirst/ Gathering Information √√√√ Summative/ Comprehensive Pulmonary Embolus/ Physical Examination √√√√ Summative/ Comprehensive Cholecystitis/ Ultrasound Skills √√√√ Summative/ Comprehensive HIPAA/ Professional Boundaries √√√√ Summative/ Comprehensive Oral Contraception/ Social and Sexual History √√√√ Summative/ Comprehensive Longitudinal SP: Hypertension Therapy √√√√ Summative/ Comprehensive

Longitudinal Planning of Communications Curriculum

Sample Curriculum Map KEY T = Taught A = Assessed Topic MS1MS2TransitionsMS3MS4 3 Function Model T, AAAAA Advanced Care Planning T, A Assessing Readiness for Change T, AA AA Breaking Bad News T, AA AA Challenging Interactions with Colleagues TAA Challenging Patients T, A A Communicating with Patients by Phone or T, A Communicating with Patients about Risk and Uncertainty T, AA Communicating with Patients about Screening T, A A

Contact Information Name Joe il.com Alice Judy a.edu Ellen edu Gigi