Monday, March 14, 2011

Tough Talk helps people be gentle

Some people at the University of Washington and colleagues from around the country run a wonderful website called Tough Talk: Helping Doctors Approach Difficult Conversations. They call it a "toolbox for medical educators" who want to teach about ethics and communication. Topics include:

Common teaching challenges plus tips for recovering from them • Optimizing small group dynamics • Providing effective, honest feedback • Helping clinicians develop and operationalize personal learning goals • Motivating engagement and self-assessment in reluctant participants

Look at this statement of philosophy:

Many argue that ethics and communication cannot be taught. Since these skills lie in the realm of the interpersonal, they do build on skills and practices we begin developing from our earliest interactions. However, evidence shows that practice and experience can lead to development and enhancement of these skills. This human element is where the moral work of medicine happens. We have a responsibility to attend to these skills and work to develop them, even as we strive to perfect our other core clinical skills. Quality patient care depends on it.

Teaching future medical professionals is a gift. When we interact with students, residents, fellows, or colleagues, we have many opportunities to learn and grow ourselves, in addition to promoting growth in others. We have approached this work of teaching by thinking about it as a service. We are not there to impart knowledge or impress others. We are there, working with learners, because we are genuinely interested in helping them become better doctors. Ultimately, attending to the interests of physicians-in-training will promote better patient care.

This is a nice exception from the findings made by Linda Pololi in her book about the often dehumanizing relationships among faculty in medical schools.

I was curious about how it all got started and how well it is being accepted. Here's the note I received from Kelly Edwards at UW when I asked those questions:

This project started as "Oncotalk" which has a linked site to "Tough Talk", an NCI-funded program to help prepare oncology fellows for difficult conversations with seriously ill patients. We ran two retreats a year, reaching 20 fellows each time, for four years and touched many of the training programs across the country through this program. We then received a five year grant to support a 'train-the-trainer' course to teach Oncology faculty to integrate more communication skills teaching into their clinical teaching of fellows. We have had one 20 person cohort per year for four years, and our last session is coming up in April.

Tough Talk was funded by the Greenwall Foundation and allowed us early on to study our process approach to teaching communication skills and post some teaching materials to share online. I know that our programs have impacted many practicing oncologists - and many patients in return - but we do not have specific data about the public websites that support these courses to know how many additional people find these resources.

Oncotalk was profiled in the New York Times about 5 years ago. And we have several published papers in the academic literature about our program, teaching model, and communication skills. I'd be glad to share any of these papers if you are interested.

We get emails from participants on nearly a weekly basis about how their clinical practice has been impacted by our programs. As one small sign of support, 50% of the Oncotalk alums wrote letters of support for our train-the-trainer course grant. To us, that was very moving, given how busy these oncologists are!

Other faculty-investigators involved with this program are: Tony Back (oncologist at UW, Seattle - Principle Investigator), Robert Arnold (Palliative Care physician, Pittsburgh), James Tulsky (Palliative care physician, Duke), and Walter Baile (Psychiatrist at MD Anderson). They are truly leaders in the field!


nasov said...

So glad to see this. Everybody is teachable!

Elaine Schattner, MD said...

Thanks for writing on this important program.

Training can help oncologists "deal" better with these subjects and speak more compassionately with their patients about tough subjects. But when it comes down to everyday work - out of the instructional realm - these conversations come more easily to some doctors than others.

mdspencer said...

BIDMC Ob-Gyn did a patient panel in which three patients talked about how doctors talk. It was terrific.