A Developmentally-Based,
Integrated Curriculum in
Communication and
Interpersonal Skills for
Medical Students:
Bringing this to your Home
Institution
Joseph S. Weiner, MD, PhD; Alice Fornari, EdD;
Marie Barilla-Labarca, MD; Ruth Ellen Pearlman,
MD;
Judith Brenner, MD
Hofstra North Shore-LIJ School of Medicine
Hempstead, NY
Overview
• Summary of Communication
Curriculum at the Hofstra North
Shore-LIJ School of Medicine
– Communication Training
• Core Skills
• Longitudinally refined skills
– Faculty development
– Assessment
• Breakout tables will explore these
topics in more detail
Hofstra Curriculum
• Pedagogic Foundations
– Values-Based Curriculum
• Communication is a theme that
weaves through all four years
Aligned Values, Principals
and Goals Drives Good
Outcomes
Longitudinal
Curriculum
Coordination
Communication
Training
Assessment
Drives Learning
Alignment
Hofstra Curriculum
• Pedagogic Foundations
– Three Function Model [Cole and
Bird]
• Function 1: Establish an effective
relationship.
– Interpersonal skill development
• Function 2: What is the problem or
issue?
– Information gathering and synthesis
• Function 3: Shared education,
motivation and treatment planning.
– Decision making models
– Motivational interviewing
– Longitudinal patient care
Hofstra Curriculum
• Pedagogic Foundations
– Skills-Based Training
• Minimal lecture
– Knowledge is not an endpoint
– Knowledge facilitates skill development
• Guided Practice
– Role play; Standardized patients;
Immediate clinical exposure
• Communication skills should be
immediately applicable to the
students’ clinical experiences.
Hofstra Curriculum
• Pedagogic Foundations
– Assessment
• Multiple domains [Verbal/Written
Communication, Self Assessment,
Individual and Group Video Review]
• Skills based assessment [standardized
patients, coaching]
• Formative and Summative
• Assessment drives learning
Integration Throughout
Structure
Communication,
Professionalism,
Physical
Diagnosis
Patient,
Physician,
Society
Clinical Experience
Skills Relevant to the
Student’s Professional Life
• Intensive introductory course (7
weeks)
– Deconstruction of basic,
generalizable skills
– Developmentally appropriate
• Focus on function 1 [relationship
building]
• Focus on function 2 [information
gathering and synthesis of the
problem]
• Clear demarcation in the curriculum
with Function 3 [treatment planning
and education]
– Verbal and written communication
skills
Relevant Skills : MS-1
Developmental Progression
• Summer MS-1 [First 7 Weeks of
Med School]
– Core Communication Skills
•
•
•
•
•
•
•
Initial Engagement with a Patient
Chief Complaint and HPI
Highly Specific Empathy Skills
PMH, Medication,…., Social History
Practice an Interview with an SP
Trust Building
Cognitive Exam
Relevant Skills : MS-1
Developmental Progression
• Fall MS-1
– Communication about screening
tests
– Obtaining a sexual history
– Sharing difficult (“bad”) news
• Winter MS-1
– Communication with
Children/Adolescents: Chronic
Illness
– Readiness for Change
– Screening for Problem Drinking
Relevant Skills :
Developmental Progression
• Winter MS-1
– Intimate Partner Violence:
screening for a history of abuse
– Screening for problem drinking
• Spring MS-1
– Motivational Interviewing: Lifestyle
Choices
– Motivational Interviewing: Smoking
Cessation
Faculty Development
• Recruitment
• Introduction to skills-based
training
– Philosophic shift from passive
learning
• Training in “Giving Feedback”
• Training in Coaching/Role Play
Assessment
• Interaction with Standardized
Patient
• Aligning the taught skills with
assessment
• Some unfamiliar scenarios to give
the student a chance to apply
taught skills [formative]
• Formative assessment
• Summative assessment
Resources
• Core Communication Team
• Faculty (Salaried and Voluntary)
• Assessment Center
– Medical Director
– Standardized Patient Trainer
– SP Rooms/Video/Data Storage
– Standardized Patient Pool
• Curriculum Time
Core Communication Skills Training
Alignment with the Medical School
Select the Heuristic Model
Combine Faculty Development and Curriculum
Design (Maximizes Faculty Devotion)
Coordinate Assessment with Curriculum Design
Teach the Course, Assess Outcomes, Individually
Synthesize Assessment with Learning Objectives
Outcomes
1.
2.
3.
4.
5.
6.
7.
Specific Skills-Based
Learning Objectives:
Verbal Communication
Written Communication
Self Assessment
Exposure to Coaching
Initial Engagement with a Patient
Chief Complaint and HPI, Part I
Chief Complaint and HPI, Part II
Highly Specific Empathy Skills
Practice an Interview with an
SP/Full History
Trust Building
Cognitive Exam
Our 7-Week
Core
A Sample Class
1.
2.
3.
4.
Goals
Learning Objectives
Pre-reading
Class Plan (Highly Structured)
•
•
•
•
Framing lecture (20 minutes)
Large or small group discussion (20
minutes)
Skills-based Practice/Role Play (60
minutes)
Discussion (10 minutes):
–
–
What will you immediately apply?
What are ongoing challenges?
Faculty Development Core
Principles
Form a cadre of diverse
faculty across disciplines
and professions-use
them as your core
teaching faculty
“Communications
Faculty”
Sense of Ownership of
the Curriculum/Personal
Satisfaction/Improve
own skills
Faculty
Developm
ent
Experiential Learning ie
“Learn by Doing”
Advances GME and
UGME
Assessment Drives Learning
Classroom Communications Session
Standardized Patient Interaction
Self Assessment and Individual Feedback with
SP and Faculty
Synthesized Feedback and Discussion with
Longitudinal Faculty Mentor
Group and/or Individual Videotape Review
A
representative
week
Weeks
devoted to
Assessment
Assessment: Formative and
Summative
CLINICAL SKILLS EXERCISES FOR ACADEMIC YEAR 2011-2012
Competency
Course
Station Name
Back Pain/
Empathy
Pneumonia/
Building Rapport
CPR RIA Week
BI RIA Week
FTB RIA Week
HOM RIA Week
Medical Knowledge
Patient Care
Interpersonal Skills
and Communication
Professionalism
Formative or Summative
√
√
√
√
Formative
√
√
√
√
Formative
Prenatal Visit/
Building Rapport
√
√
√
√
Formative
Longitudinal SP:
Abdominal Pain
√
√
√
√
Formative
Recurrent CHF/
Health Care Proxy
√
√
√
√
Formative
HIV Testing/
Social History
√
√
√
√
Formative
Genetic Screening/
Delivering Difficult
News
√
√
√
√
Formative
Longitudinal SP:
Chest Pain
√
√
√
√
Formative
√
√
√
√
Formative
√
√
√
√
Formative
√
√
√
√
Formative
√
√
√
√
Summative/
Comprehensive
Vaccines/ Cultural
Competency/
Curiosity, Empathy
and Respect
√
√
√
√
Summative/
Comprehensive
Excessive Thirst/
Gathering
Information
√
√
√
√
Summative/
Comprehensive
Pulmonary
Embolus/ Physical
Examination
√
√
√
√
Summative/
Comprehensive
√
√
√
√
Summative/
Comprehensive
√
√
√
√
Summative/
Comprehensive
√
√
√
√
Summative/
Comprehensive
√
√
√
√
Summative/
Comprehensive
DM/ Lifestyle
Assessment
Postnatal Visit/
Empathy and NonVerbal
Communication
Longitudinal SP:
Blood in Stool
Gout/ Seven
Characteristics of a
Symptom
Cholecystitis/
Ultrasound Skills
HIPAA/
Professional
Boundaries
Oral
Contraception/
Social and Sexual
History
Longitudinal SP:
Hypertension
Therapy
Longitudinal Planning of
Communications
Curriculum
Develop List of Core Skills
Map Skills to Curricular Periods
Assess Skills at Intervals
Modify Curriculum to Address Gaps
Provide Opportunities for Practice
Track Students’ Progress Over Time
Integrate Skills Practice/Assessment into Other Venues
Sample Curriculum Map
Topic
3 Function
Model
Advanced Care
Planning
Assessing
Readiness for
Change
Breaking Bad
News
Challenging
Interactions
with Colleagues
Challenging
Patients
Communicating
with Patients by
Phone or Email
Communicating
with Patients
about Risk and
Uncertainty
Communicating
with Patients
about Screening
MS1
MS2
Transitions
MS3
MS4
T, A
A
A
A
A
T, A
T, A
T, A
T, A
A
A
A
T, A
A
A
A
A
A
T, A
A
T
T, A
T, A
T, A
T, A
A
KEY
T = Taught
A = Assessed
A
Contact Information
Name
Email
Joe Weiner
josephweinermd@gma
il.com
Alice Fornari
afornari@nshs.edu
Judy Brenner
Judith.Brenner@hofstr
a.edu
Ellen Pearlman
R.E.Pearlman@hofstra.
edu
Gigi Barilla-Labarca
Mbarrilla@nshs.edu