Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication

Lauren J. Taylor, Sarah Adkins, Andrew Warfield Hoel, Joshua M Hauser, Pasithorn Suwanabol, Gordon Wood, Wendy Anderson, Carolina Branson, Steven Skube, Sara K. Johnson, Amy Zelenski, Jennifer L. Tucholka, Toby C. Campbell, Margaret L. Schwarze*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.

Original languageEnglish (US)
Pages (from-to)165-173
Number of pages9
JournalJournal of Surgical Education
Volume76
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

training program
Communication
Education
resident
communication
science
Checklist
instructor
Program Evaluation
conversation
resources
Mental Competency
Learning
communication skills
Surgeons
education
video
leader
learning
Group

Keywords

  • Communication
  • Education
  • End-of-life
  • Interpersonal and Communication Skills
  • Patient Care
  • Surgery
  • Systems-Based Practice

ASJC Scopus subject areas

  • Surgery
  • Education

Cite this

Taylor, Lauren J. ; Adkins, Sarah ; Hoel, Andrew Warfield ; Hauser, Joshua M ; Suwanabol, Pasithorn ; Wood, Gordon ; Anderson, Wendy ; Branson, Carolina ; Skube, Steven ; Johnson, Sara K. ; Zelenski, Amy ; Tucholka, Jennifer L. ; Campbell, Toby C. ; Schwarze, Margaret L. / Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication. In: Journal of Surgical Education. 2019 ; Vol. 76, No. 1. pp. 165-173.
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abstract = "Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results: Attendance rates ranged from 16{\%} to 75{\%}. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69{\%} strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100{\%} felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.",
keywords = "Communication, Education, End-of-life, Interpersonal and Communication Skills, Patient Care, Surgery, Systems-Based Practice",
author = "Taylor, {Lauren J.} and Sarah Adkins and Hoel, {Andrew Warfield} and Hauser, {Joshua M} and Pasithorn Suwanabol and Gordon Wood and Wendy Anderson and Carolina Branson and Steven Skube and Johnson, {Sara K.} and Amy Zelenski and Tucholka, {Jennifer L.} and Campbell, {Toby C.} and Schwarze, {Margaret L.}",
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Taylor, LJ, Adkins, S, Hoel, AW, Hauser, JM, Suwanabol, P, Wood, G, Anderson, W, Branson, C, Skube, S, Johnson, SK, Zelenski, A, Tucholka, JL, Campbell, TC & Schwarze, ML 2019, 'Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication', Journal of Surgical Education, vol. 76, no. 1, pp. 165-173. https://doi.org/10.1016/j.jsurg.2018.05.015

Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication. / Taylor, Lauren J.; Adkins, Sarah; Hoel, Andrew Warfield; Hauser, Joshua M; Suwanabol, Pasithorn; Wood, Gordon; Anderson, Wendy; Branson, Carolina; Skube, Steven; Johnson, Sara K.; Zelenski, Amy; Tucholka, Jennifer L.; Campbell, Toby C.; Schwarze, Margaret L.

In: Journal of Surgical Education, Vol. 76, No. 1, 01.01.2019, p. 165-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication

AU - Taylor, Lauren J.

AU - Adkins, Sarah

AU - Hoel, Andrew Warfield

AU - Hauser, Joshua M

AU - Suwanabol, Pasithorn

AU - Wood, Gordon

AU - Anderson, Wendy

AU - Branson, Carolina

AU - Skube, Steven

AU - Johnson, Sara K.

AU - Zelenski, Amy

AU - Tucholka, Jennifer L.

AU - Campbell, Toby C.

AU - Schwarze, Margaret L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.

AB - Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.

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