Residents in NYU Langone’s Department of Neurology are sharpening their interpersonal communication and professionalism skills as part of an innovative program that utilizes planned simulation scenarios. The goal is to help the residents prepare for a wide range of clinical situations, as well as interactions with patients, families, and colleagues. Teaching interpersonal skills alongside concrete clinical skills is part of the department’s innovative efforts to enhance future clinicians’ capacity to deliver high-quality patient care.
Integrating Physician Professionalism Within Neurological Training
Exceptional physician professionalism and communication skills have been linked in prior research to improved medical outcomes and higher treatment adherence, as well as higher patient satisfaction and retention. Although such skills are espoused as core competencies for trainees by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME), these governing organizations do not provide specific guidance on evidence-based approaches to build these more amorphous skills among residents.
To fill the gap, leaders in the Department of Neurology looked to the simulation center—long used in resident education to convey clinical skills such as acute stroke management, lumbar puncture, and direct ophthalmoscopy—to provide a structured, standardized environment exposing all residents to scenarios demanding key professional skills. “The qualities that help a physician succeed are emphasized in medical school, but drop off in residency as the focus turns to the specific clinical skills required by a specialty,” says Arielle M. Kurzweil, MD, assistant professor of neurology and director of the Neurology Residency Program. “We wanted to apply the technology and resources we have within the simulation center to create a customized curriculum that would develop residents’ professionalism and communication skills.”
Standardizing Clinical Scenarios Through Simulation
The curriculum applies objective structured clinical examinations (OSCEs)—simulated scenarios enacted by actors dubbed standardized professionals—across a range of scenarios that could be encountered within neurological practice. In the simulations, the resident interacts with a standardized professional playing the role of a patient, a family member, or a medical colleague in 10-minute, predetermined scenarios, and then receives immediate, direct feedback from an observing faculty member based on tenets of effective communication and professionalism.
“Within the course of medical practice, there are so many variables at play—we can’t guarantee that every resident will obtain sufficient experience delivering a difficult diagnosis or in other specific communication challenges,” notes Dr. Kurzweil. “With simulation, we are able to standardize every resident’s exposure to situations they will eventually encounter within the rigors of real-world clinical care.”
The OSCEs are segmented by levels of training, with four discrete scenarios for junior residents at the beginning of their training and four more complex scenarios for senior residents with more experience. Junior residents encounter a co-resident who is depressed and using alcohol; walk through a transition of care to other residents amid distractions; navigate a conversation with a colleague who challenges the suggested management of a patient; and convince a stroke patient to consent to tissue plasminogen activator (tPA) treatment. Senior residents create a treatment plan for a patient injured by a medical error made by another service; deliver a difficult diagnosis of psychogenic seizures; present a poor neurological prognosis to a cardiac patient’s family; and provide a medical student with constructive feedback.
A paper documenting the department’s use of simulation in teaching and assessing communication and professionalism in neurology was co-authored by Dr. Kurzweil and accepted for publication in Neurology. The paper, also presented at the 2019 American Academy of Neurology (AAN) meeting, reports positive benefits of the OSCEs as reflected in a survey of residents regarding the program’s effectiveness. “As we continue to implement the OSCEs in resident training, we will seek to gather data on how they translate into enhanced patient care quality,” says Dr. Kurzweil. “Anecdotally, we do know that residents have reported directly utilizing skills they developed during the OSCEs within their clinical rotations.”
Establishing Skills Before They’re in Demand
The simulation curriculum to foster professional skills is one element of a focused department effort to deliver the most comprehensive, well-rounded experience possible in neurology education—encompassing both clinical knowledge and patient interaction skills needed to deliver high-quality neurological care. Other initiatives include a “boot camp” for incoming adult and pediatric neurology and neuropsychiatry residents, which replaces the first week of clinical duties with intensive didactics covering neuroanatomy, neurologic examination, neuroradiology, lumbar puncture, and neurologic emergencies. The week concludes with a case-based review, followed by a self-assessment for residents to report their comfort with prospective practice of clinical neurology. An abstract on the approach was also presented at the 2019 AAN meeting.
“The goal of these efforts is to establish both basic neurologic skills and best practices in those softer humanistic skills so that residents are ultimately prepared for the wide-ranging scenarios that arise in patient care,” concludes Dr. Kurzweil. “We surveyed our faculty to determine whether residents seem to be more prepared to hit the wards and take care of patients, and overwhelmingly, the answer is yes.”