Teaching Residents Patient-Centered Communication: A Call for Standardized Programming

Objective: Surgical residency Program Directors (PDs) use the Accreditation Council for Graduate Medical Education (ACGME) milestones to measure general surgery competencies including interpersonal communication skills and professionalism. These programs face myriad barriers implementing communication training, including competing educational priorities and insufficient local expertise. The goal of this work is to generate hypotheses regarding barriers and facilitators to successful communication, leadership, and professionalism training (CLPT) in surgical residency programs.

Design and setting: We implemented a qualitative study using semi structured 30-minute interviews; grounded theory guided our systematic data collection, coding, and analysis to enable us to identify patterns and relationships within the available dataset.

Participants: Eligible participants were surgical educators known to provide or interested in providing communication training or were surgical trainees focused on education and/or CLPT. Surgeon participants (N=18) included 4 communication researcher/content experts, 9 Program Director (PD) or former PD faculty, 4 Associate PDs, 1 fellow, and 2 residents.

Results: Themes abstracted from interview data include 1) the importance of providing formal CLPT, 2) readiness of residency programs to include CLPT, 3) challenges and barriers to implementing CLPT, and 4) recommendations for implementation. Barriers included the "crowded educational schedule," lack of local expertise, absence of programmatic guidance nationally, and paucity of standardized materials. Facilitators to implementation included the nature of CLPT curricula such as content, approach, and ease of implementation, and suggestions to achieve learner and leadership support. The availability of expert guidance and standardized materials would ease the incorporation of sustainable CLPT into a residency program that could become increasingly engaged and skilled in communication.

Conclusions: This research serves as a call for direction from ACGME regarding CLPT educational priorities and urges surgical educators to continue to test and develop CLPT content and assessment materials for wide distribution along with providing guidance on implementation.