PedsTalk: A Pilot Communication Skills Education Course for Pediatric Residents Free

PedsTalk was created in collaboration with VitalTalk-trained adult medicine faculty at our institution using content adapted from a pediatrics-focused VitalTalk course at the Larner College of Medicine at the University of Vermont.^1,15,16  Our 3-hour course, conducted on a virtual platform because of coronavirus disease 2019 restrictions, focused on key communication skills, including communicating serious news, responding to emotion, eliciting patient/family values, and making values-based treatment recommendations. PedsTalk included an asynchronous online module and simulation-based roleplay with trained actors. Components of PedsTalk are discussed further in our previous work and online VitalTalk material.^1,17  Small groups were facilitated by VitalTalk-trained faculty paired with pediatric faculty “Communication Champions,” who had received communication skills training.¹ 

Course participants were residents across postgraduate years present at the program’s weekly academic conference, with attendance based on a predetermined rotation schedule. Participants completed demographic surveys and rated confidence with 9 communication skills using a 5-point Likert scale before, immediately after, and 4 months after course participation. Nonparticipants, residents unable to attend because of inpatient responsibilities, completed surveys and acted as controls. Survey questions mirrored the VitalTalk framework and were designed to assess study aims (understanding resident communication experiences and examining communication skill confidence). For example, to determine confidence in skills, respondents identified their level of agreement/disagreement with the statement: “I am confident in my ability to recognize emotion in patients/families.” Responses were analyzed by using Friedman tests and Wilcoxon rank tests. Respondents provided free-text responses to questions about communication experiences with pediatric patients/families. Before PedsTalk, residents were asked about communication challenges in pediatrics. Immediately after the course, individuals were queried about takeaway lessons, and at 4 months follow-up, they were asked to reflect on recent communication experiences. By using Braun and Clarke’s approach, a thematic analysis was performed to analyze free-text responses.¹⁸  Three authors (CC, KG, SK) reviewed responses for initial themes which were revised to reach concordance.

This project was designated as exempt human subjects research by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai.

Twenty-seven residents (approximately one-third of our pediatric residency program) took the PedsTalk course, 11 of whom completed surveys at all 3 timepoints. Eleven course nonparticipants completed surveys at all timepoints and served as controls. Both participants and controls were lost to follow-up. Most participants identified as White and female and were 26 to 30 years old (Table 1). Most participants received <5 hours of formal communication education during residency, with “observing senior team members” cited as the most common method of communication education. All endorsed the need for communication skills training during residency.

Participants’ confidence in the following communication skills was retained or significantly improved over time: difficult conversations (P < .001), recognizing emotion (P < .01), using silence (P < .008), headline statements (P < .001), eliciting “VALUES”, (P < .001), and asking permission to continue (P < .001; Table 2). Over time, controls had significant improvements in confidence in 2 skills: headline statements (P < .014) and eliciting “VALUES” (P < .031; Supplemental Table 4).

When queied about communication challenges in pediatrics, 3 themes were identified: pediatric patient, parent/guardian, and pediatric provider (Table 3). Within each of these areas, the following subthemes emerged: understanding the situation, emotional response, advocate, and practice uncertainty. For example, acknowledging the emotional challenge of communicating bad news to parents, one respondent wrote: “It’s heartbreaking to have to share this news and I think it’s difficult to keep my own emotion out of the conversation.” After the course, participants reported learning and practicing numerous new communication skills, such as “Ask-Tell-Ask” and responding to emotion, with one respondent setting a goal to “develop a more concrete headline before speaking with famil[ies].” Lastly, at 4 months follow-up, respondents reflected on recent communication experiences and reported using communication skills in their clinical practice, including: “NURSE statements like Understanding”, “ask-tell-ask to clarify bad news”, and allowing for silence.

Participation in PedsTalk positively impacted resident confidence in 6 of 9 key communication skills. This is congruent with previous work revealing that dedicated simulation-based communication education positively impacts trainee communication skills, such as responding to emotion and eliciting patient/family values.^10,19,20  Novel to our study is the application of the VitalTalk framework to pediatric resident education. VitalTalk offers residents a safe space to practice communication skills in a group setting with faculty coaching and peer feedback. Through these constructive discussions and the ability to “replay” parts of conversations with actors for additional practice, participants may gain more experience using communication skills and augment their confidence.

Although participation in PedsTalk was associated with increased confidence in 6 skills, pediatric residents who did not participate also reported increased confidence in 2 skills (forming headline statements and eliciting values). Because our survey did not query why nonparticipants felt more confident with these skills over time, this warrants further exploration. It has been shown that trainees observe experienced clinicians to inform their own practice as physicians, especially with respect to communication skills.^1,2,6  Informal exposure to senior pediatricians communicating serious news to patients/families may be an effective form of communication skills education. However, this relies on the senior provider demonstrating effective communication skills. The creation of pediatric Communication Champions is an example of an initiative to improve communication skills among faculty to model skills and educate trainees, which may be useful given scheduling constraints that make large-scale trainings, such as PedsTalk, difficult.¹  Such continuous modeling may allow for better resident skill retention. Residents who completed PedsTalk may also model communication skills and this may represent another form of informal teaching.

Given the variety of communication challenges reported, it is not surprising that respondents endorsed a need for communication skills education in our initial survey. Challenges, such as difficulty responding to emotion, are frequently encountered in serious illness conversations and may be addressed by using the communication skills taught in PedsTalk. Reported PedsTalk takeaway lessons reflected the communication skills taught in the course, indicating concrete skills learned by participants. At 4 months post-PedsTalk, when asked about a recent communication experience, respondents reported using many of the skills learned in the course, demonstrating its longitudinal impact and relevance to clinical practice.

There are several limitations to our study. As a single-center study with a small sample size, the generalizability of our findings is uncertain. Our primary study outcome, the self-assessment of communication skill confidence, carries inherent limitations as self-reported confidence does not necessarily reflect one’s effectiveness in conversations with patients/families.²¹  Exploring the impact of PedsTalk on resident communication with patients/families warrants study. Resident confidence with serious illness communication may differ with actors versus real patients and may not be the best measure of intervention impact as, for example, residents may report increased confidence due to a belief that they should gain competence over time. There is no standard timeframe for assessing the maintenance of communication skills.^10,12,22,23  Further work should be done to establish maintenance of skills after 4 months. Although communication jargon was defined before survey administration, it is possible that respondents did not understand specific terms, such as headline, which may impact results. Additionally, the majority of mean ranks decreased between the immediate post-course survey and 4 months post-course. Our methods do not enable us to explore why this may be and warrants further study. It is possible that individuals who completed our survey were more positively impacted by PedsTalk compared with those who did not complete the survey, or alternatively, the reverse may be true.

Participation in PedsTalk was associated with improved confidence in several key serious illness communication skills among pediatric residents. Although communication skills training and routine clinical experiences may separately augment confidence in communication skills, combining these modalities may further enhance confidence in these skills among trainees. Given its positive impact, our approach to communication skills education may be a model for enhancing communication competencies among pediatric residents.

The authors wish to acknowledge the Department of Pediatrics at the Icahn School of Medicine at Mount Sinai for grant support through the Pediatric Scholars Awards Program.