ACGME expectations for radiology trainees’ proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.
Introduction
As originally outlined in the core competencies of the Accreditation Council of Graduate Medical Education (ACGME) in the late 1990s, radiology program directors are responsible for helping their trainees meet basic expectations for proficiency in communication . With the advent of the ACGME Milestones, this communication competency has been further clarified to help assess residents’ performance. The milestones now require that residents be able to communicate effectively with patients, families, and caregivers in both routine and complex conversations (Interpersonal and Communication Skills ICS2 from the ACGME Radiology Milestones) . In addition, residents must be able to convey results of imaging studies effectively with members of the health care team both during interdisciplinary conferences and through their radiology reports (Interpersonal and Communication Skills ICS1 from the ACGME Radiology Milestones) .
The ACGME expectations echo a now sizable chorus of leaders in radiology who have long beseeched the field to embrace more direct patient communication as a matter of optimal patient-centered care, in which care better incorporates patients’ preferences and values, recognizes the needs of diverse communities, and ultimately leads to improved health care satisfaction and outcomes . Specific initiatives advanced by radiologic professional organizations to encourage such practices include the American College of Radiology (ACR) Commission on Patient- and Family-Centered Care (formerly the ACR Patient Experience Commission) ACR’s Imaging 3.0 , the Radiological Society of North America (RSNA) Radiology Cares Program , and The American Board of Radiology (ABR) Maintenance of Certification Program . These programs promote a unified vision that understands augmented patient-centered care as a major vehicle through which to achieve high value practice .
These standards challenge program directors to address communication competencies within their training curricula, and to develop both educational resources and assessment tools for their residents. Over time, numerous teaching resources and pedagogical approaches have materialized that target patient-related communication skills specifically for radiology. Currently, however, these tools are scattered independently throughout the literature, on various websites, and elsewhere. No organized catalogue of existing resources is available, which makes it difficult for training programs to incorporate and synthesize them into coherent, formalized communication curricula. A major gap thus exists in the competency expectations that have been established by the ACGME and radiology leadership, and the formalized curricular opportunities within training programs to teach this competency.
A growing trove of web-based material offers courses, vignettes, lectures, videos, case-studies, and compilations of relevant literature. Innovative pedagogical approaches have been developed that incorporate key elements of microteaching, adult education and simulation into teaching and assessing communication and interpersonal skills in radiology. More general devices such as mnemonics, scripts, and articles have also been published to assist residents with patient-related communication. Tools exist already to assess competency in communication and interpersonal skills, for example the Gap Kalamazoo Communication Assessment Tool for radiologists . This paper aims to address the gap by reviewing and compiling these resources into a toolkit that will help residencies develop curricula around patient-centered communication. With this review, we hope to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.
Web-Based Resources
The RSNA Professionalism Committee and Radiology Cares campaign, as well as the ACR Imaging 3.0 program and the Commission on Patient- and Family-Centered Care (PFCC) all house websites that collectively represent an extensive online repository of patient-centered radiology tools for radiologists . Much of these materials address patient-related communication directly.
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TABLE 1
Summary of Easily Accessible Web-Based Forms of Education in the Art of Communication (Reviewed from November 2014-August 2017)
Website Resources Within Site Number/Type of Resources Cost RSNA Professionalism 1. Vignettes on Professionalism ( http://www.rsna.org/Professionalism_Vignettes/ ) 12 – each vignette has a set of cases with questions and explanations. Free 2. Ethics and Professionalism Online courses ( http://www.rsna.org/ethics-and-professionalism/ ) 11 – each course ends with a quiz to receive CME credit and a course evaluation. Requires RSNA membership. 3. Professionalism Educational Toolkit ( http://www.rsna.org/Professionalism-Educational-Toolkit/ ) A. Online Education: Courses—Difficult Conversations in Medicine: Practical Tips to Enhance Your Practice = Total of 4 lectures 4 – Taped presentations by various authors utilizing PowerPoint presentations. Free B. Scientific journals/publications and other resources: Over 50 resources. 11 specific for resident education Free Radiology Cares Educational Toolkit Free 1. Scientific journals/publications, news items, and web-based resources: Over 180 resources. 8 specific for resident education. 2. Patient-centered Care Videos ( http://www.rsna.org/Patient-centered_Radiology_Literature.aspx ) 8 – includes patient’s personal stories and Radiologists discussing patient-centered care. ACR Imaging 3.0 Online—Patient Engagement ( https://www.acr.org/Practice-Management-Quality-Informatics/Imaging-3/Case-Studies/Patient-Engagement ) 20 Case Studies—discussion about real-life scenarios on utilizing patient-centered care. Free Patient-and-Family Centered Care Resources ( https://www.acr.org/Advocacy/Economics-Health-Policy/Imaging-3/PEC-Resources ) Multiple links, articles, blogs, etc. – mostly related to radiology as a field and patient centered-care. Free AUR Professionalism Curriculum Resources ( https://www.aur.org/Secondary.aspx?id=1241 ) 9 case based sessions—case scenarios with built in reflective questions for group discussion. Free AMSER Professionalism Modules: The Medical Student or The Resident as a Professional in Radiology: Self Learning Module ( https://www.aur.org/Secondary-Alliances.aspx?id=793 ) Interactive powerpoint presentation with questions, answers, and discussion. Free APDR Milestone Resources: 12 folders, one for each milestone, describing the milestone and suggested educational strategies. { https://apdr.org/template.aspx?id=1004 ) Examples of educational strategies includes under communication: evaluation forms, checklists, reading suggestions, lectures, Modified Boston Children’s PERCS Program. Free
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Innovative Communication Curricula
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Microteaching
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TABLE 2
Five Steps of Microteaching
Steps Objectives Pre-observation Student teacher presents lesson plan to a small group of co-students and facilitator Observation Group acts as class in the simulated lesson; videotaped. Analysis Student teacher leaves, and group/facilitator analyze Self-viewing Student teacher views videotape of themselves teaching Supervisory conference 1.Student teacher present his/her analysis
2.Group leader discusses their analysis
3.Free discussion
(Adapted from : Lang, E. V., Sood, A., Anderson, B., Kettenmann, E., Armstrong, E. Interpersonal and communication skills training for radiology trainees using a rotating peer supervision model (microteaching). Academic Radiology 2005; 12:901–908.)
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Simulation-Based Training
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Mnemonics, Scripts and General Aids
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TABLE 3
Mnemonics to Enhance Communication
Medical Field Mnemonic Meaning Oncology SPIKES S—setting up the interview
P—assess the patient
I—invite the patient
K—give knowledge to patient
E—address patient’s emotions
S—strategy and summary End-of life-care ABCDE A—advance preparation by MD
B—build therapeutic relationship
C—communicate well
D—deal with patient reactions
E—encourage/validate emotions Pediatric Radiology RADPED R—rapport
A—ask
D—discuss
P—perform procedure
E—exam distraction techniques
D—discuss
(References , Respectively).
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Future Directions
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Conclusion
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