victoria brazil: communication in the heat of battle
DESCRIPTION
Brazil illustrates the depth of communication required in medical practice between people within health care delivery systems.TRANSCRIPT
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Communication in the heat of battle
Victoria Brazil
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Communication is our most important clinical skill
There are some specific challenges in critical care
Training helps……a bit
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Communication is our most important clinical skill
There are some specific challenges in critical care
Training helps……a bit
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Communication is our most important clinical skill
• Most frequently performed• Greatest diagnostic utility• Saves lives• Best medicolegal defence• Most frequent problems if poorly
performed• Best skill to keep you happy at the end of
the day
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Your day…….
36.5 communication events per hour
A third of communication events are interruptions
10% are concurrent conversations
Coiera etc al Med J Aust 2002; 176 (9): 415-418.
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Your consultation
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You saving lives
• Urgently
• Not so urgently
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Your patients’ safety..
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Your best medicolegal defence
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Your happiness at the end of the day……..
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Communication is our most important clinical skill
There are some specific challenges in critical care
Training helps……a bit…..
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Teamwork and leadership
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Crisis resource Management (CRM)
• Know your environment• Call for help early • Take a leadership role• Communicate effectively• Maintain situational awareness• Distribute the workload
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Crisis resource Management (CRM)
• Know your environment• Call for help early • Take a leadership role• Communicate effectively• Maintain situational awareness• Distribute the workload
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Training for CRM
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Handovers
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Interprofessional communication
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Tribes are big in healthcare….
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Cross cultural communication
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Communication is our most important clinical skill
There are some specific challenges in critical care
Training helps……a bit
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Simulation anyone..?
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Communication skills for “early learners”
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“Hello my name is……..”
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“Training in communication skills
does not necessarily lead to skilled communication”
BEME Guide no 2: Teaching and Learning communication skills in medicine. Medical Teacher 1999
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Gender matters
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Getting more from our SPs…..?
( Vic sees the light after 8 years of mannequin
sim……!)
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Patient care interaction with heightened arousal
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More confederates…
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SPs and ‘patient voice’
“There have been times if I am playing the role of a woman from the lower echelons of society, that I have actually felt the student’s disdain for me as a person. …
…..Perhaps the student did not realise he was showing disdain.”
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“I have played the role of a pregnant mother who has been told her unborn baby has Down Syndrome. ..
In this situation I have been met with many varied responses… From nervous laughter, to distracted looks, to a complete lack of empathy……. I really feel the pain of that pregnant mother. ………I am physically crying and totally distraught.
……………. And if the responses to this situation are not right, I will tell the student exactly what is lacking, which is so often sensibility.”
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SPs and Cultural issues
‘I just can’t do this [shaking head]’
—female medical student refuses to apply ECG electrodes to male SP Instructor
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‘Crossing Boundaries’ “The Standardized Patient Instructor has an essential role in preparing and training medical students to break through that barrier. ………….the SP has a dual role of patient advocate and student educator, ……..requires deep sensitivity, psychological awareness, sociocultural knowledge and a commitment far beyond passive participation…….
……. Medical students need clinical scenarios that trigger conflict between the accepted notion of duty of care and personal socio-cultural values……….
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………..Triggering the conflict opens the door to learning opportunities and bridge building;
……that is, the creation of acceptable compromises that will preserve the integrity of personal beliefs and values while upholding foundational bioethical and legal principles……...”
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Lets think about some simulated patient educators for postgraduate training?
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Handovers
• SBAR, isoBAR…….
• Training needs to be customised, and recognise context…..hierarchies, tribalism and more
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Simulating patient journeys
Med student …..
“When the doctor isn’t there - who looks after the patients…?”
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Simulating patient journeys -communication for advanced
practitioners
“STEMI-sim”
• Using sim to improve the care of real patients with STEMI at our institution
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CL prep
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Most valuable aspects?
• “The debrief as an entire group, was the most valuable part of this exercise. I felt it gave an opportunity to identify and discuss the entire process, (STEMI Patient), with other personnel that normally we would only interact with, in passing. “
• “Being able to 'stand back' and observe the process, allowing identification of potential areas of delay and ideas for improvement ‘
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Results – STEMI patient data
• Baseline (july –Dec 2010)– Median ‘Door to lab’ 60 mins (n= 35)
• Post ‘stemi-sim’ ( July – Dec 2011)– Median ‘Door to lab’ 27 mins (n= 22)
• p = 0.003
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Communication is our most important clinical skill
There are some specific challenges in critical care
Training helps……a bit