@article{4ed0b6870f1b49a6a8ca8fc681565add,
title = "Assessing Nephrology Fellows{\textquoteright} Skills in Communicating About Kidney Replacement Therapy and Kidney Biopsy: A Multicenter Clinical Simulation Study on Breaking Bad News",
abstract = "Rationale & Objective: Interpersonal communication skills and professionalism competencies are difficult to assess among nephrology trainees. We developed a formative “Breaking Bad News” simulation and implemented a study in which nephrology fellows were assessed with regard to their skills in providing counseling to simulated patients confronting the need for kidney replacement therapy (KRT) or kidney biopsy. Study Design: Observational study of communication competency in the setting of preparing for KRT for kidney failure, for KRT for acute kidney injury (AKI), or for kidney biopsy. Setting & Participants: 58 first- and second-year nephrology fellows assessed during 71 clinical evaluation sessions at 8 training programs who participated in an objective structured clinical examination of simulated patients in 2017 and 2018. Predictors: Fellowship training year and clinical scenario. Outcome: Primary outcome was the composite score for the “overall rating” item on the Essential Elements of Communication–Global Rating Scale 2005 (EEC-GRS), as assessed by simulated patients. Secondary outcomes were the score for EEC-GRS “overall rating” item for each scenario, score < 3 for any EEC-GRS item, Mini-Clinical Examination Exercise (Mini-CEX) score < 3 on at least 1 item (as assessed by faculty), and faculty and fellow satisfaction with simulation exercise (via a survey they completed). Analytical Approach: Nonparametric tests of hypothesis comparing performance by fellowship year (primary goal) and scenario. Results: Composite scores for EEC-GRS overall rating item were not significantly different between fellowship years (P = 0.2). Only 4 of 71 fellow evaluations had an unsatisfactory score for the EEC-GRS overall rating item on any scenario. On Mini-CEX, 17% scored < 3 on at least 1 item in the kidney failure scenario; 37% and 53% scored < 3 on at least 1 item in the AKI and kidney biopsy scenarios, respectively. In the survey, 96% of fellows and 100% of faculty reported the learning objectives were met and rated the experience good or better in 3 survey rating questions. Limitations: Relatively brief time for interactions; limited familiarity with and training of simulated patients in use of EEC-GRS. Conclusions: The fellows scored highly on the EEC-GRS regardless of their training year, suggesting interpersonal communication competency is achieved early in training. The fellows did better with the kidney failure scenario than with the AKI and kidney biopsy scenarios. Structured simulated clinical examinations may be useful to inform curricular choices and may be a valuable assessment tool for communication and professionalism.",
keywords = "Breaking bad news, clinical education, competency milestone, interpersonal communication skills, kidney failure, nephrology fellow, patient counseling, patient education, professionalism, simulated patient, simulation",
author = "Prince, {Lisa K.} and Howle, {Anna M.} and Jeffrey Mikita and Y'Barbo, {Brian C.} and Maynard, {Sharon E.} and Sussman, {Amy N.} and Maursetter, {Laura J.} and Oliver Lenz and Scalese, {Ross J.} and Sozio, {Stephen M.} and Scott Cohen and Watson, {Maura A.} and Robert Nee and Yuan, {Christina M.}",
note = "Funding Information: Lisa K. Prince, MD, Anna M. Howle, MAc, Jeffrey Mikita, MD, Brian C. Y'Barbo, MD, Sharon E. Maynard, MD, Amy N. Sussman, MD, Laura J. Maursetter, DO, Oliver Lenz, MD, MBA, Ross J. Scalese, MD, Stephen M. Sozio, MD, MHS, MEHP, Scott Cohen, MD, Maura A. Watson, DO, MPH, Robert Nee, MD, and Christina M. Yuan, MD. Authors LKP, B'YB, SEM, ANS, LJM, SC, MAW, and RN are members of the Nephrology Education Research and Development Consortium (NERDC). Research idea and study design: LKP, AMH, RN, MAW, BY'B, CMY; data acquisition: LKP, AMH, JM, BY'B, SEM, ANS, LJM, OL, SMS, RJS, SC, MAW, RN, CMY; data analysis/interpretation: LKP, AMH, BY'B, RN, CMY; statistical analysis: RN, CMY; supervision or mentorship: LKP, AMH, JM, RJS, CMY; simulation: AMH, JM, RJS. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This work was supported by Walter Reed National Military Medical Center Simulation Center (WRNMMC), which provided financial support and use of the facility. The authors declare that they have no relevant financial interests. We would like to thank the 58 fellows, 24 faculty, and simulated patients at 5 simulation centers who participated. Aside from the authors involved in scenario development/data collection and analysis (WRNMMC) and simulation (WRNMMC and University of Miami), the participants included WRNMMC nephrology fellows who served as beta testers (Evan Fisher, Sarah Gordon, Kendral R. Knight, Ryan Altenberg, Heather Mascio, and Deepti Moon) and the following Nephrology Fellowship Programs: Walter Reed National Military Medical Center, George Washington University, University of Wisconsin, Lehigh Valley Hospital Network, University of Miami, Georgetown University, Johns Hopkins University, and University of Arizona. The views expressed are those of the authors and do not reflect the official policy of the Department of the Army/Navy/Air Force, the Department of Defense, nor the US Government. Received July 15, 2020. Evaluated by 3 external peer reviewers, with direct editorial input from a Statistics/Methods Editor and an Associate Editor, who served as Acting Editor-in-Chief. Accepted in revised form February 13, 2021. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies. Funding Information: This work was supported by Walter Reed National Military Medical Center Simulation Center (WRNMMC), which provided financial support and use of the facility. Publisher Copyright: {\textcopyright} 2021",
year = "2021",
month = oct,
doi = "10.1053/j.ajkd.2021.02.323",
language = "English",
volume = "78",
pages = "541--549",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
number = "4",
}