Alan W. Dow

Using Theater to Teach Clinical Empathy: A Pilot Study

BackgroundClinical empathy, a critical skill for the doctor–patient relationship, is infrequently taught in graduate medical education. No study has tested if clinical empathy can be taught effectively.ObjectiveTo assess whether medicine residents can learn clinical empathy techniques from theater professors.DesignA controlled trial of a clinical empathy curriculum taught and assessed by 4 theater professors.SettingVirginia Commonwealth University, Richmond, Virginia, a large urban university and health system.ParticipantsTwenty Internal Medicine residents: 14 in the intervention group, 6 in the control group.InterventionSix hours of classroom instruction and workshop time with professors of theater.MeasurementsScores derived from an instrument with 6 subscores designed to measure empathy in real-time patient encounters. Baseline comparisons were made using two-sample T tests. A mixed-effects analysis of variance model was applied to test for significance between the control and intervention groups.ResultsThe intervention group demonstrated significant improvement (p ≤ .011) across all 6 subscores between pre-intervention and post-intervention observations. Compared to the control group, the intervention group had better posttest scores in 5 of 6 subscores (p ≤ .01).LimitationsThe study was neither randomized nor blinded.ConclusionsCollaborative efforts between the departments of theater and medicine are effective in teaching clinical empathy techniques.

Applying organizational science to health care: a framework for collaborative practice.

Developing interprofessional education (IPE) curricula that improve collaborative practice across professions has proven challenging. A theoretical basis for understanding collaborative practice in health care settings is needed to guide the education and evaluation of health professions trainees and practitioners and support the team-based delivery of care. IPE should incorporate theory-driven, evidence-based methods and build competency toward effective collaboration. In this article, the authors review several concepts from the organizational science literature and propose using these as a framework for understanding how health care teams function. Specifically, they outline the team process model of action and planning phases in collaborative work; discuss leadership and followership, including how locus (a leader’s integration into a team’s usual work) and formality (a leader’s responsibility conferred by the traditional hierarchy) affect team functions; and describe dynamic delegation, an approach to conceptualizing escalation and delegation within health care teams. For each concept, they identify competencies for knowledge, attitudes, and behaviors to aid in the development of innovative curricula to improve collaborative practice. They suggest that gaining an understanding of these principles will prepare health care trainees, whether team leaders or members, to analyze team performance, adapt behaviors that improve collaboration, and create team-based health care delivery processes that lead to improved clinical outcomes.

An exploratory study of an assessment tool derived from the competencies of the interprofessional education collaborative

Abstract Linking the outcomes from interprofessional education to improvements in patient care has been hampered by educational assessments that primarily measure the short-term benefits of specific curricular interventions. Competencies, recently published by the Interprofessional Education Collaborative (IPEC), elaborate overarching goals for interprofessional education by specifying desired outcomes for graduating health professions students. The competencies define a transition point between the prescribed and structured educational experience of a professional degree program and the more self-directed, patient-oriented learning associated with professional practice. Drawing on the IPEC competencies for validity, we created a 42-item questionnaire to assess outcomes related to collaborative practice at the degree program level. To establish the usability and psychometric properties of the questionnaire, it was administered to all the students on a health science campus at a large urban university in the mid-Atlantic of the United States. The student responses (n = 481) defined four components aligned in part with the four domains of the IPEC competencies. In addition, the results demonstrated differences in scores by domain that can be used to structure future curricula. These findings suggest a questionnaire based on the IPEC competencies might provide a measure to assess programmatic outcomes related to interprofessional education. We discuss directions for future research, such as a comparison of results within and between institutions, and how these results could provide valuable insights about the effect of different curricular approaches to interprofessional education and the success of various educational programs at preparing students for collaborative practice.

Patient Safety Attitudes and Behaviors of Graduating Medical Students

As North American medical schools reformulate curricula in response to public calls for better patient safety, surprisingly little research is available to explain and improve the translation of medical students’ knowledge and attitudes into desirable patient safety behaviors in the clinical setting. A total of 139 fourth-year medical students at Virginia Commonwealth University, School of Medicine, 96% of the 2010 graduating class, completed the Attitudes toward Patient Safety Questionnaire and a self-report of safety behaviors. The students were exposed to informal discussions of patient safety concepts but received no formal patient safety curriculum. Most students recognized errors and responded with attitudes supportive of patient safety but desired behaviors were less common. In particular, errors went unreported, owing, in part, to the relationships of power and social influence undergirding the traditional authority gradient in the culture of medicine. A deeper understanding of patient safety attitudes, behavior, and medical culture is required to better inform instructional design decisions that influence desired patient safety behaviors and improve patient care.

The effects of expanding primary care access for the uninsured: implications for the health care workforce under health reform.

The Patient Protection and Affordable Care Act seeks to improve health equity in the United States by expanding Medicaid coverage for adults who are uninsured and/or socioeconomically disadvantaged; however, when millions more become eligible for Medicaid in 2014, the health care workforce and care delivery systems will be inadequate to meet the care needs of the U.S. population. To provide high-quality care efficiently to the expanded population of insured individuals, the health care workforce and care delivery structures will need to be tailored to meet the needs of specific groups within the population. To help create a foundation for understanding the use patterns of the newly insured and to recommend possible approaches to care delivery and workforce development, the authors describe the 13-year-old experience of the Virginia Coordinated Care program (VCC). The VCC, developed by Virginia Commonwealth University Health System in Richmond, Virginia, is a health-system-sponsored care coordination program that provides primary and specialty care services to patients who are indigent. The authors have categorized VCC patients from fiscal year 2011 by medical complexity. Then, on the basis of the resulting utilization data for each category over the next fiscal year, the authors describe the medical needs and health behaviors of the four different patient groups. Finally, the authors discuss possible approaches for providing primary, preventive, and specialty care to improve the health of the population while controlling costs and how adoption of the approaches might be shaped by care delivery systems and educational institutions.

The effects of power, leadership and psychological safety on resident event reporting.

Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under‐reported, especially by frontline providers such as resident physicians.

Refinement of the IPEC Competency Self-Assessment survey: Results from a multi-institutional study

ABSTRACT Effective interprofessional practice requires interprofessional education that facilitates learners’ achievement of competency in the interprofessional domains. Unfortunately, educators currently have a limited number of tools to identify the level of competency of their learners. Previous investigations by some of the authors described the initial characteristics of a tool based on the Competencies for Interprofessional Collaborative Practice. Building on this work, this study describes a multi-institutional, three-part study refining this tool. The series of studies further established the validity, reliability, and usability of the assessment tool. Based on the data derived from this study, we created a shorter, more easily utilised version of the tool that retains previous psychometric strengths. This article describes a tool that consists of two domains, one linked to interprofessional interaction and one linked to interprofessional values. It is believed that this assessment tool may help educators define competence in interprofessional practice and guide assessment of both programmes and learners.

Understanding patient care as a multiteam system

Abstract Purpose The purpose of this chapter is to highlight some of the critical multiteam system (MTS) issues that are faced in healthcare by utilizing case studies that illustrate the transition of a patient through the healthcare system and suggest a possible approach to studying these issues. Design/methodology/approach The approach taken by the authors is a case study approach, which is used to illustrate the transition of a patient through several venues in a healthcare system. This approach elucidates the MTS nature of healthcare. Moreover, a methodological explanation, social network analysis (SNA), for exploring the description and analysis of MTSs in healthcare is provided. Findings The case study approach provides concrete examples of the complex relationship between providers caring for a single patient. The case study describes the range of shared practice in healthcare, from collaborative care within each setting to the less obvious interdependence between teams across settings. This interdependence is necessary to deliver complex care but is also a source of potential errors during care. SNA is one tool to quantify these relationships, link them to outcomes, and establish areas for future research and quality improvement efforts. Originality/value This chapter offers a unique holistic view of the transition of a patient through a healthcare system and the interdependency of care necessary to deliver care. The authors show a methodology for assessing MTSs with a discussion of utilizing SNA. This foundation may offer promise to better understand care delivery and shape programs that can lead to improvement in care.

The moving target: outcomes of interprofessional education

With the explosion of enthusiasm for interprofessional education as a means to increase collaborative practice and improve important healthcare outcomes, many institutions are devoting new resources to interprofessional educational programs. Although most interprofessional education programs described in the literature are discrete curricular events with relatively short assessment periods (Abu-Rish et al., 2012; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013), a few institutions have outlined larger institutional frameworks for their interprofessional education programs (Blue, Mitcham, Smith, Raymond, & Greenberg, 2010). In order to reach the overarching goal of interprofessional education that improves the health of patients, longitudinal curricula should include sequenced educational experiences that build toward proficiency in practice (Josiah Macy Jr. Foundation, 2013). As leaders of large interprofessional education programs at our respective institutions, we describe the challenges facing this goal and some possible approaches to being successful.

Improving quality in systems of care: Solving complicated challenges with simulation‐based continuing professional development

The delivery of quality health care depends on the successful interactions of practitioners, teams, and systems of care comprising culture. Designing educational programs to improve these interactions is a major goal of continuing professional development, and one approach for educational planners to effect desired changes is simulation-based education. Because simulation-based education affords an opportunity for educators to train health care professionals in environments that resemble clinical practice, this instructional method allows planners to integrate overarching priorities for improvement in health care practice with the training goals of individuals. Educational planners should consider how to structure scenarios to meet training objectives based on the complicated interactions within the health care system. To optimize the benefit of simulation-based experiences, evidence and insights from industrial and organizational psychology, as well as from human factors studies, provide guidance to the planning process, and interdisciplinary studies of complex health care systems can help produce educational programs that improve the quality of health care delivery.