Impact of Communication Skills Curriculum on Comfort and Competence with Difficult Conversations in Neonatal Perinatal Medicine

Abstract

Background Communication skills are vital in neonatal-perinatal medicine (NPM). Despite this, limited NPM fellowship programs have a standardized curriculum for training, and survey-based studies have shown that most fellows feel uncomfortable engaging in difficult conversations. Objective To assess the impact of a 2-year structured communications skills training curriculum on self-reported comfort using a survey-based questionnaire, and to objectively assess competence using a simulation test for NPM fellows using 360-degree evaluation by two different neonatologists, a “mock parent” and an NPM fellow. Methodology A series of four didactic lectures and 11 simulation sessions were conducted over 2 years. The comfort and competence of fellows were assessed using pre- and post-training self-assessed comfort (SAC) surveys, as well as two simulation-based communication skills assessment tests (CSATs) following the training. The fellow, mock parent, and two neonatologists independently assessed the fellows’ performance following the CSAT using an evaluation tool. Results A total of 11 fellows completed training (19 SAC surveys and 54 CSAT evaluations). Fellows reported higher comfort scores following the training [median pre-SAC score: 22.5 (IQR 18-27); post-SAC: 31 (IQR 26-36); P = .01]. Additionally, analysis of the evaluation of the CSAT score showed improvement with increasing levels of training [PGY4: 22 (IQR 16-23), PGY5: 21 (IQR 14-22), PGY6: 23 (IQR 21-24), P = .04] and between the first and second attempts [first: 20.5 (IQR 14-23), second: 23.5 (IQR 20-24), P = .03]. No difference in score was found between different raters. Fellows scored lowest in the use of appropriate verbal and/or non-verbal language [SPIKES skills 9 (IQR 8-10), language 8 (IQR 7-8), emotional scores 8.5 (IQR 8-9), P = .003]. Conclusion The incorporation of a structured communication skills training can play a vital role in the comfort levels of NPM fellows conducting difficult conversations and can improve competence following communication skills training.