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Education Research: Communication skills for neurology residents

Structured teaching and reflective practice

From the Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry (C.J.W.), and Centre for Studies in Family Medicine (J.B.B.), University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Dr. Christopher J. Watling, Department of Clinical Neurological Sciences, London Health Sciences Centre–Victoria Hospital, Room C3-302, 800 Commissioners Road East, London, Ontario, Canada N6A 5W9 chris.watling{at}lhsc.on.ca

Objective: Despite the importance of communication skills for neurologists, specific training in this area at the residency level is often lacking. This study aimed to enhance learning of these skills and to encourage reflective practice around communication skills.

Methods: A group of 12 neurology residents participated in a series of six case-based communication skills workshops. Each workshop focused on a particular clinical scenario, including breaking bad news, discussing do-not-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent for neurologic tests and procedures, and discussing life-and-death decisions with families of critically ill patients. Residents also kept reflective portfolios in which real examples of these interactions were recorded.

Results: The program was well accepted, and residents rated the workshops as effective and relevant to their practice. Analysis of residents’ portfolios revealed three themes relevant to patient–physician communication: 1) communication is more successful when adequate time is allowed, 2) the ability to empathize with patients and their families is essential to successful interactions, and 3) the development of specific approaches to challenging scenarios can facilitate effective interactions. The portfolios also demonstrated that residents would engage in reflective practice.

Conclusions: Targeting of communication skills training around specific clinical scenarios using neurologic cases was well accepted and was deemed relevant to practice. The use of portfolios may promote lifelong learning in this area.

Abbreviations: ALS = amyotrophic lateral sclerosis; DNR = do-not-resuscitate; ER = emergency room; ICU = intensive care unit; MS = multiple sclerosis; tPA = tissue plasminogen activator.

Disclosure: The authors report no conflicts of interest.

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