Structured, easy-to-interpret approaches are needed to facilitate preference-sensitive decision-making about cancer treatments. The TrialTalk method incorporates a verbal component and a pen-and-paper diagram that outlines the diagnosis, prognostic implications, treatment options, potential outcomes, and anticipated impacts on daily life. This pilot study examined (1) oncologists’ ability to learn and then implement the tool in their clinical practice and (2) the effect of the TrialTalk method on clinical trial consent and enrollment. Twenty-seven oncologists from a single academic institution were randomly assigned to the intervention group (n = 14) or the control group (n = 13). Intervention group oncologists completed a single, 2-hour TrialTalk training program including a didactic, simulated session with patient actors and feedback from the trainer. Additional feedback and question/answer sessions were available. Oncologists in the control group did not receive TrialTalk training. Clinical trial decisions were collected from patients seen by oncologists in both groups. Intervention oncologists demonstrated fidelity with the tool after training. Patients of oncologists in the intervention group were significantly more likely to consent to participate in clinical trials than patients of oncologists in the control group (92.9

INTRODUCTION:Promotion pathways for clinician educators (CEs) at academic institutions can be unclear, partially due to the specialization of faculty in education and the heterogeneity of their roles. Little specific guidance exists on promotion for CEs; therefore, we examined the lived experiences of recently promoted faculty to identify successful strategies that help early career CEs achieve promotion. METHODS:We conducted a qualitative study utilizing semistructured interviews of 19 associate and full professors to explore their successes, missteps, what they would have done differently, and advice to early-career faculty. Inductive analysis included individual review and group consensus. After generating codes and collapsing them into themes, we used the Social Cognitive Career Theory framework for higher-level analysis. RESULTS:Themes were organized into 2 categories: (1) advice for new CEs and (2) what institutions should offer. Individual strategies included finding mentors and sponsors, developing scholarship in education, and establishing career direction. Institutional strategies included providing formal or informal training, ensuring protected time, and minimizing nonmeaningful work for early-career faculty. DISCUSSION:Given the lack of specificity in promotion guidelines for CEs, these themes offer guidance from faculty who successfully navigated promotion. These can inform both early-career faculty and departments seeking to support CE advancement. CONCLUSIONS:Successful promotion for CEs depends on mentorship and sponsorship, scholarship development, career direction, and institutional support. These findings provide actionable strategies for faculty and leadership to improve clarity and equity in promotion processes.

Introduction: Patients with rectal cancer face a potentially life-limiting disease with multi-modal treatment options conferring substantial symptom burdens. Treatment decisions frequently require trade-offs and input from a multidisciplinary team: ideal cases for shared decision-making. Using qualitative analysis, we characterized the content of communication between surgeons and patients who have rectal cancer. Methods: We performed secondary analysis of audio-recorded clinic visits of patients with rectal cancer (n = 18) with colorectal surgeons (n = 8) at 5 academic centers. Four coders used inductive content analysis with an analytical emphasis on communication about decision-making. Results: Surgeons focused on communicating technical details of potential treatment pathways. Patients sought information around prognosis, functional changes, long-term recovery, and next steps. Surgeons laid groundwork for shared decision-making; patient goals were not routinely clarified. Decisions were typically deferred due to uncertainty and missing information needed to determine appropriate treatment options. Conclusions: Our findings suggest avenues for surgeons to enhance communication around rectal cancer decisionmaking: acknowledging uncertainty and providing concrete information when able, focusing on topics such as prognosis, tradeoffs, and long-term recovery, and clarifying patient preferences.

Outcomes 1. Employ scenario planning to help family members of seriously ill patients better anticipate and prepare for possible outcomes.2. Utilize communication tools like Best Case/Worst Case-ICU to support collaboration on multidisciplinary teams caring for seriously ill patients. Key Message Best Case/Worst Case-ICU (BC/WC-ICU) is a communication tool that we implemented at eight trauma centers in a clinical trial. In interviews to characterize clinician perceptions of effectiveness, clinicians reported improved family understanding of prognosis and a shared understanding of the patient's trajectory among all members of the clinical team. Abstract Best Case/Worst Case-ICU (BC/WC-ICU) uses scenario planning to communicate prognosis for older adults with serious injury. Preliminary studies show measurable improvements in the quality of communication and a preference for this approach by patients who mistrust the medical system (1,2). To evaluate effectiveness, we implemented this intervention at eight high-volume trauma centers across the United States. Objectives To characterize clinician perceptions of effectiveness of the BC/WC-ICU intervention. Methods We implemented BC/WC-ICU at eight sites covering a patient population that is 56% White, 34% Black, 6% Asian, and 21% Hispanic, training ICU clinicians (nurses, advanced practice professionals, surgical residents, fellows and staff) to use the communication tool daily on rounds. We conducted semi-structured interviews with 5-12 clinicians per site. We coded transcripts deductively using the implementation framework of Normalization Process Theory and inductively developed additional codes related to the perceived benefits of BC/WC-ICU. Results Clinicians reported the BC/WC-ICU tool improves communication with families and has additional value for the clinical team. They noted families understand prognosis better (“they really seem to get it now, how sick grandpa is”), especially when the prognosis declined over time. Clinicians also found BC/WC-ICU useful for interprofessional communication. It ensured a shared understanding of prognosis among team members (“we're all on the same page…this person is probably not going to leave the ICU”), which promoted consistent communication across the team, and taught trainees who may be bogged down in the details to consider the big picture. Implementation challenges included understaffing, high patient volume, and competing priorities on rounds. Conclusions Our findings suggest that BC/WC-ICU supports families as they confront a loved one's worsening prognosis and benefits individual clinicians and the multidisciplinary team. BC/WC-ICU helps multidisciplinary teams use advanced communication techniques to minimize mixed messages and keep team members and families on the same page. References 1. Zimmermann CJ, Zelenski AB, Buffington A, et al. Best case/worst case for the trauma ICU: Development and pilot testing of a communication tool for older adults with traumatic injury. J Trauma Acute Care Surg. 2021;91(3):542-551. 2. Blumenthaler AN, Robinson KA, Hodge C, et al. Communication Frameworks for Palliative Surgical Consultations: A Randomized Study of Advanced Cancer Patients. Ann Surg. 2023;278(5):e1110-e1117.

In this commentary, we use Reiss and White’s contention of educational aims as a lens to examine the aims of medical education and determine whether the flourishing of medical students is among them. We identify an absence of flourishing and observe descriptions of medical students as finished products of training with an emphasis on professional virtues such as altruism. This emphasis is a compensatory response to professional and cultural shifts during the twentieth century. Anchored by this historical context, we draw on the work of Fielding and Moss to offer a path forward for redefining the aims of medical education.

Background Certain patients significantly challenge the care team, increasing the risk of burnout as clinicians struggle to perform their best work while meeting the needs of their patients. Imagining another's perspective, a clinical empathy skill, can increase compassion and lower distress when interacting with these patients. Objective To evaluate the effectiveness of an art-based perspective-taking activity on clinicians' feelings of discomfort when anticipating encounters with challenging patients. Methods This museum-based session was conducted from 2017 to 2022 (virtual sessions in 2020) by faculty trained in using arts-based methods to teach. Residents (n=142) in a university-based internal medicine residency program along with health professionals, trainees, and faculty (n=12) attending an international conference were invited to participate. Participants recalled a challenging patient, chose a piece of art that might be meaningful to this person, and discussed their choice and insights gained. Participants completed pre-post ratings of anticipated discomfort. Inaugural participants submitted written reflections on these ratings. Data were analyzed using paired t tests and content analysis. Results Five 90-minute sessions were conducted with 65 internal medicine residents and 12 faculty; 75 of 77 total participants completed pre-post discomfort ratings (response rate 97.4%). Anticipated discomfort decreased after sessions (mean pre=5.38; post=4.13; P<.01). Open-ended responses aligned with a transition from self to other focus in perspective-taking. Costs were minimized by using art from a campus museum, paper and pencil surveys, and faculty academic time. Conclusions This innovative visual arts-based activity to increase empathy for challenging patients is simple, feasible, self-contained, and cost-effective.

Women and underrepresented-in-medicine applicants value a climate for diversity when selecting graduate medical education training programs. Climate may not be accurately represented during virtual recruitment. Optimizing program websites may help overcome this barrier. We reviewed websites for adult infectious disease fellowships that participated in the 2022 National Resident Matching Program for emphasis on diversity, equity, and inclusion (DEI). Fewer than half expressed DEI language in their mission statement or had a dedicated DEI statement or webpage. Programs should consider emphasizing their commitment to DEI prominently on their websites, which may help recruit candidates from diverse backgrounds.

Objective: To describe the outcomes of training nephrology clinicians and clinical research participants, to use the Best Case/Worst Case Communication intervention, for discussions about dialysis initiation for patients with life-limiting illness, during a randomized clinical trial to ensure competency, fidelity to the intervention, and adherence to study protocols and the intervention throughout the trial. Methods: We enrolled 68 nephrologists at ten study sites and randomized them to receive training or wait-list control. We collected copies of completed graphic aids (component of the intervention), used with study-enrolled patients, to measure fidelity and adherence. Results: We trained 34 of 36 nephrologists to competence and 27 completed the entire program. We received 60 graphic aids for study-enrolled patients for a 73% return rate in the intervention arm. The intervention fidelity score for the graphic aid reflected completion of all elements throughout the study. Conclusion: We successfully taught the Best Case/Worst Case Communication intervention to clinicians as research participants within a randomized clinical trial. Innovation: Decisions about dialysis are an opportunity to discuss prognosis and uncertainty in relation to consideration of prolonged life supporting therapy. Our study reveals a strategy to evaluate adherence to a communication intervention in real time during a clinical study.

Background Burnout is prevalent in medical training. While some institutions have implemented employee-to-employee recognition programs to promote wellness, it is not known how such programs are perceived by resident physicians, or if the experience differs among residents of different genders. Methods We used convergent mixed methods to characterize how residents in internal medicine (IM), pediatrics, and general surgery programs experience our employee-to-employee recognition ("Hi-5″) program. We collected Hi-5s received by residents in these programs from January 1, 2021–December 31, 2021 and coded them for recipient discipline, sex, and PGY level and sender discipline and professional role. We conducted virtual focus groups with residents in each training program. Main measures and approach We compared Hi-5 receipt between male and female residents; overall and from individual professions. We submitted focus group transcripts to content analysis with codes generated iteratively and emergent themes identified through consensus coding. Results Over a 12-month period, residents received 382 Hi-5s. There was no significant difference in receipt of Hi-5s by male and female residents. Five IM, 3 surgery, and 12 pediatric residents participated in focus groups. Residents felt Hi-5s were useful for interprofessional feedback and to mitigate burnout. Residents who identified as women shared concerns about differing expectations of professional behavior and communication based on gender, a fear of backlash when behavior does not align with gender stereotypes, and professional misidentification. Conclusions The “Hi-5” program is valuable for interprofessional feedback and promotion of well-being but is experienced differently by men and women residents. This limitation of employee-to-employee recognition should be considered when designing equitable programming to promote well-being and recognition.

Objective: Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams. Methods: Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice. Results: Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team. Conclusions: The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings. Innovation: We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.

IntroductionPoor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.Methods and analysisWe will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or ‘like family’ member per eligible patient 5–7 days following their loved ones’ admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients’ length of stay in the ICU.Ethics and disseminationInstitutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings.Trial registration numberNCT05780918.

BACKGROUND:Empathy declines during medical training, despite its importance. METHODOLOGY:In this randomized controlled trial, we assessed the impact of Zoom improv on medical student empathy using a concurrent mixed-methods approach. Quantitative assessment with three survey tools and qualitative assessment by content analysis of Zoom session field notes were conducted. RESULTS:Zoom improv participants had higher empathy scores in perspective-taking and fantasy and lower scores in personal distress compared with the control group. Medical students who participated in Zoom improv exercised emotional expression, active listening, and giving "gifts," which apply to healthcare settings in which affirming team members with empathic concern can advance communication, patient rapport, and teamwork. DISCUSSION:This pilot study highlights promising findings for the incorporation of Zoom improv in medical education, including enhanced empathy, self-reflection, and understanding how these skills impact work in healthcare. Future studies may expand on the optimal timing to teach improv. Future studies conducted on virtual platforms may also further investigate our finding that the fantasy domain of empathy increases after Zoom improv sessions, whereas this increase in fantasy was absent from previous in-person studies. Given the increase in telehealth and virtual medical visits, exercising empathy skills through a screen during training may be an important addition to medical curricula.

Introduction Surgeons are entrusted with providing patients with information necessary for deliberation about surgical intervention. Ideally, surgical consultations generate a shared understanding of the treatment experience and determine whether surgery aligns with a patient’s overall health goals. In-depth assessment of communication patterns might reveal opportunities to better achieve these objectives. Methods We performed a secondary analysis of audio-recorded consultations between surgeons and patients considering high-risk surgery. For 43 surgeons, we randomly selected 4 transcripts each of consultations with patients aged ≥60 y with at least 1 comorbidity. We developed a coding taxonomy, based on principles of informed consent and shared decision making, to categorize surgeon speech. We grouped transcripts by treatment plan and recorded the treatment goal. We used box plots, Sankey diagrams, and flow diagrams to characterize communication patterns. Results We included 169 transcripts, of which 136 discussed an oncologic problem and 33 considered a vascular (including cardiac and neurovascular) problem. At the median, surgeons devoted an estimated 8 min (interquartile range 5–13 min) to content specifically about intervention including surgery. In 85.5% of conversations, more than 40% of surgeon speech was consumed by technical descriptions of the disease or treatment. “Fix-it” language was used in 91.7% of conversations. In 79.9% of conversations, no overall goal of treatment was established or only a desire to cure or control cancer was expressed. Most conversations (68.6%) began with an explanation of the disease, followed by explanation of the treatment in 53.3%, and then options in 16.6%. Conclusions Explanation of disease and treatment dominate surgical consultations, with limited time spent on patient goals. Changing the focus of these conversations may better support patients’ deliberation about the value of surgery. Trial registration: ClinicalTrials.gov Identifier: NCT02623335. Highlights In decision-making conversations about high-risk surgical intervention, surgeons emphasize description of the patient’s disease and potential treatment, and the use of “fix-it” language is common. Surgeons dedicated limited time to eliciting patient preferences and goals, and 79.9% of conversations resulted in no explicit goal of treatment. Current communication practices may be inadequate to support deliberation about the value of surgery for individual patients and their families.

Hierarchy and status and power differentials in current health care practice persist, despite recognition of their ethical issues and movement toward collaborative practice. As interprofessional education continues to emphasize shifting from individual siloed practice to team-based approaches to improving patient safety and outcomes, addressing status and power is key to mutual respect and trust cultivation. What has become known as medical improv applies techniques of theater improvisation to health professions education and practice. This article shares how an improv exercise called Status Cards prompts participants to recognize their responses to status and how this awareness can be applied to improve their interactions in real encounters with patients, colleagues, and others in health care contexts.

Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2–6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.

Objective:Applied improvisation (AI) is an approach used in health professions (HP) education to teach skills essential for clinical practice such as communication, teamwork, and empathy. Little is known about which skills can be developed using AI, or those which an AI should prioritize. Our research aims to identify skills essential to include in an AI curriculum for HP learners.Methods:A modified nominal group technique (NGT) was conducted to identify and prioritize specific skills which can be taught using AI. This involved silent generation of ideas, round robin, discussions, 2-rounds of preliminary voting, and a final ranking survey to determine a prioritized list of skills to include in an AI curriculum for HP learners.Results:Six content experts participated in the NGT meeting. Initially, 83 skills were identified, and through NGT, a final list of 11 skills essential to an AI curriculum were determined including: adaptability, affirmation of others, acceptance, active listening, being present, cooperation, collaboration with other, advancement, compassionate communication, sharpened non-verbal communication, resilience.Conclusion:Essential skills for an AI curriculum relate to adaptability, attunement, collaboration, affirmation, and advancement.Innovation:This study is a novel application of NGT as a strategy to organize an approach to curriculum innovations.