Commentary: First Do No Harm: Preserving Patient Safety Without Sacrificing Procedural Education (p. 499)

In response to Grover et al (p. 548), Wayne and Holmboe emphasize balancing patient safety and educational progress, and recommend structure, working with faculty, and opportunities to demonstrate competence.

Leadership Development for Program Directors (p. 502)

Bing-You and colleagues applied leadership assessment and development tools during a program directors' retreat. They discuss how this can benefit program directors' professional development and positive leadership behavior.

The Morbidity and Mortality Conference: A Unique Opportunity for Teaching Empathic Communication (p. 505)

Teaching the skills of empathic

Invasive procedures are performed every day by physicians-in-training in American hospitals. Specific procedures vary from surgical interventions performed in the operating room to procedures such as bronchoscopy, temporary dialysis catheter insertion, and endoscopy performed at the bedside. A delicate balance exists in each situation because performing the procedure safely is paramount for patients, while acquiring clinical skills is a critical objective for medical learners. Maintaining this balance also is made challenging by critically ill patients, complex procedures, and the varying competence and experience of individual trainees. The difficulty in balancing these interests is shown by the fact that complications related

Abstract

Background

Residency program directors have increasingly challenging roles, but they may not be receiving adequate leadership development.

Objective

To assess and facilitate program directors' leadership self-awareness and development at a workshop retreat.

Methods

At our annual program director retreat, program directors and associate program directors from a variety of specialties completed the Thomas-Kilmann Conflict Mode Instrument (TKI), which evaluates an individual's behavior in conflict situations, and the Hersey-Blanchard Situational Leadership (HBSL) model, which measures individuals' preferred leadership style in working with followers. Participants received their results during the retreat and discussed their leadership style results in the context of conflict situations experienced in the past. An online survey was distributed 3 weeks after the retreat to assess participant satisfaction and to determine whether participants would make changes to their leadership styles.

Results

Seventeen program directors attended the retreat and completed the tools. On the TKI, 47% preferred the Compromising mode for handling conflict, while 18% preferred either the Avoiding or Accommodating modes. On the HBSL, 71% of program directors preferred a Coaching leadership style. Ninety-one percent of postretreat-survey respondents found the leadership tools helpful and also thought they had a better awareness of their conflict mode and leadership style preferences. Eighty-two percent committed to a change in their leadership behaviors in the 6 months following the retreat.

Conclusions

Leadership tools may be beneficial for promoting the professional development of program directors. The TKI and HBSL can be used within a local retreat or workshop as we describe to facilitate positive leadership-behavior changes.

Abstract

Background

The morbidity and mortality conference is an educational tradition in American medicine that dates to the early 20th century. Traditionally, this conference has focused entirely on issues of diagnosis and treatment, in the context of a disappointing clinical outcome.

Intervention

We report on a new method for teaching empathic doctor-patient communication skills at an obstetrics and gynecology morbidity and mortality conference. For each case presented, we identified the communications challenges and allowed faculty and residents to “practice” the discussion they would have with the patient and the patient's family in that situation. In some sessions, actors assumed the role of the patient. Following the discussion of the case, we offered didactic presentations on how we communicate with patients and their families. These focused on techniques for being patient centered and included the use of body language, open-ended questioning, reflective listening before offering to explain, and the importance of naming and validating emotions.

Results

The majority of participants felt the sessions to be helpful, and after one month many were able to identify a positive change in their interactions with patients.

Conclusions

We believe that this unique teaching format allows learners to refine their communication skills in the context of situations that they know to be both realistic and important.

Abstract

Background

Residency programs desire assessment tools for teaching and measuring resident attainment of the Accreditation Council for Graduate Medical Education competencies, including interpersonal and communication skills.

Objective

We sought to evaluate the use of emotional intelligence (EI) assessment and training tools in assessing and enhancing interpersonal and communication skills.

Methods

We used a quasi-experimental design, with an intervention and control group composed of 1 class each of family medicine residents. The intervention was EI coaching. The assessment used the Emotional and Social Competence Inventory, a 360-degree EI survey consisting of self and other (colleague) ratings for 12 EI competencies.

Results

There were 21 participants in each of the 3 assessments (test, posttest, and control). Our EI coaching intervention had very limited participation due to a lack of protected time for EI coaching and residents' competing obligations. Return rates for self surveys were 86% to 91% and 66% to 68% for others. On all 3 trials, ratings by others were significantly higher than self ratings for every competence (range, P < .001–.045). None of the self ratings by the intervention group increased significantly for any of the competencies. None of the intervention group self ratings increased significantly on posttesting, whereas ratings by others increased significantly for coach/mentor (P < .001). The teamwork rating decreased significantly on both self and other ratings (P < .001). Achievement orientation was the highest intervention group posttest rating, and teamwork was the lowest.

Conclusions

EI is a necessary skill in today's health care environment, and our study found that a tool from another sector was useful in assessing resident EI skills. Because our EI coaching intervention was unsuccessful, the effects of coaching on interpersonal and communication skills could not be assessed.