Trainee intervention doesn't improve communication, end-of-life care; patient depression higher
THURSDAY, Dec. 5, 2013 (HealthDay News) -- A communication skills intervention among internal medicine and nurse practitioner trainees does not improve quality of communication (QOC) or quality of end-of-life care (QEOLC), but is associated with increased depression among patients, according to a study published in the Dec. 4 issue of the Journal of the American Medical Association, a theme issue on medical education.
J. Randall Curtis, M.D., M.P.H., from the University of Washington in Seattle, and colleagues examined the effect of a communication skills intervention among 391 internal medicine and 81 nurse practitioner trainees between 2007 and 2013. Participants were randomized to usual education (240 participants) or to an eight-session, simulation-based communication skills intervention (232 participants). Outcomes were based on 1,866 patient ratings and 936 family ratings.
The researchers observed no significant changes in QOC or QEOLC with the intervention. The mean value for patient QOC was 6.5 post-intervention and 6.3 for the control condition, while the mean value for patient QEOLC was 8.3 in both conditions. Comparing the intervention with control, no significant differences were seen in the QOC or QEOLC scores for patients (difference, 0.4 points [P = 0.15] and 0.3 points [P = 0.34], respectively) or families (difference, 0.1 points [P = 0.81] and 0.1 points [P = 0.88], respectively) after adjustment. Among patients of post-intervention trainees, the intervention correlated with significantly increased depression scores (adjusted model showed an intervention effect of 2.2; P = 0.006).
"These findings raise questions about skills transfer from simulation training to actual patient care and the adequacy of communication skills assessment," the authors write.
Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1787407 #Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1787407 )Editorial (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1787394 )