August 2001 Bulletin

Mentors to spread word

. . . communication is the bedrock of patient care.’

AAOS to help members improve skills in communications

John F. Sarwark, MD, center coaches Scott B. Schutchfield, MD (shown from back) in role-playing with Greg Carroll, PhD, director of the Bayer Institute for Health Care Communication, right, acting as a standardized patient. Others in rear are, from left, Rober E. Eilert, MD; Ramon L. Jimenez, MD; Maysel Kemp White, PhD, course manager; Kimberley J. Templeton, MD; and John S. Webster, MD

By Sandra Lee Breisch

An orthopaedic surgeon will conduct about 100,000 to 150,000 medical interviews over the span of his or her career. How many could possibly go wrong?

Could a difficult, emotionally charged patient or one with a hidden agenda challenge your communication skills? Would you grow frustrated, cold or apathetic? Or would you be empathetic and attentive to achieve a proper diagnosis, treatment plan and good outcome?

To meet these communication challenges, the Academy is at the threshold of implementing a Communication Skills Mentors Program.

The initial goal: to educate a group of 24 orthopaedic surgeons to become communication skills mentors of patient-physician communication techniques who will teach the skills to fellows and residents at 4 1/2-hour interactive workshops. "The purpose of this program is to develop effective training for orthopaedists to improve communications with patients," explains John R. Tongue, MD, the project team leader and immediate past chair of the Board of Councilors. "We all know that our medical interviews—the most common procedure we perform in our medical careers—depends upon good communication skills. A good medical interview establishes a trusting relationship resulting in higher patient and physician satisfaction, greater patient adherence to treatment plans, better outcomes and reduced risks of malpractice. We all have the ability to improve our communication skills. Yet, one has to humble himself or herself to say, ‘I can improve my communication skills.’"

To this end, the Academy has collaborated with the Bayer Institute for Health Care Communication, Inc., a non-profit foundation in West Haven, Conn. that provides patient communication training to physicians and other health care professionals, to develop an orthopaedic-specific educational model for workshops. The model includes video vignettes of patient-physician medical interviews and other material to train communication skills mentors so they can teach fellows and residents across the country.

"The AAOS is opening new vistas for other surgical specialties to improve communications with their patients," says Michael G. Goldstein, MD, a general internist, psychiatrist and Bayer’s associate director of clinical education and research. "This is the first time that Bayer has had a cooperative agreement with a medical specialty organization to collaboratively develop a communication training program for their specialty."

Bayer has made an in-kind contribution to the Academy by developing the videos and is splitting the educational costs of training the workshop mentors at Bayer faculty development courses.

Dr. Tongue helped create scripts for orthopaedic specific video vignettes to be used as teaching resources in the upcoming workshops. One of three videos was shot at the New York practice of Joseph D. Zuckerman, MD, chairman of the Council on Education, who strongly supports this program.

"The commitment that the AAOS has to this program reflects the fact that we recognize the importance of the patient-physician relationship," stresses Dr. Zuckerman. "Over the last 10 years—through the explosion of technology and all of the changes that are occurring in the health care arena—the importance of the relationship has sometimes lost its emphasis. This is the Academy’s effort to get back to basics because when you peel away all the different layers of what physicians do and patients want in health care, communication is the bedrock of patient care."

According to Dr. Tongue—a Bayer faculty member who completed the program in November 2000—the workshops are designed to enable orthopaedists to improve their communication skills, handle difficult situations and have greater satisfaction with this essential part of an orthopaedist’s daily work."The workshops are high energy learning experiences with only 20 percent of time spent on didactic teaching and 80 percent interactive," he explains. "It is very different than most of our educational training. We will use video vignettes of the medical interview and involve orthopaedists in role-playing during the course of each workshop. The Bayer educational model emphasizes that adults learn best when comparing differences. That’s why discussion and feedback are so important."


Training includes videos on physician-patient communication

The Academy has underwritten the cost of attending the Bayer faculty courses and travel costs for the mentors who will teach workshops. Workshop participants will also get 4 1/2 hours of CME credit for faculty development and possible discounts on their malpractice insurance premiums.

"The mentors are going to teach these communication skills to their colleagues, bring it to residents they train and hopefully they’re going to take it to the medical school level," explains Dr. Zuckerman.

Six Academy members completed Bayer’s five-day faculty development program conducted in Milford, Conn on June 17-22. They are Robert E. Eilert, MD; Ramon L. Jimenez, MD; John F. Sarwark, MD; Scott B. Scutchfield, MD; Kimberly J. Templeton, MD; and John S. Webster, MD.

Dr. Eilert, a Rose Brown Professor of Orthopaedics and Pediatrics at the University of Colorado Health Science Center and former member of the AAOS Board of Directors, says he has learned valuable communication tools.

As incoming president of the Western Orthopaedic Association, Dr. Eilert plans to present newly learned communication techniques at the association’s next annual meeting, as well as to medical students and residents at the University of Colorado, and to members of the Rocky Mountain Orthopaedic Society.

Additionally, Dr. Eilert says he learned how to ask patients more open-ended questions and to negotiate a treatment plan with the patient to achieve a "better buy-in" for improved patient adherence.

"At the end of the faculty course, we were asked to pick two out of the 43 communication procedures which we learned how to incorporate into our practice," says Dr. Eilert. "I’m planning to test these procedures for about six weeks and then follow-up with the Bayer Institute."

Dr. Templeton, who practices at the University of Kansas Medical Center, says she’s particularly interested in this cause because research has shown "there is a problem with the public’s perception" of orthopaedic surgeons. "Patients see us as technicians—but we aren’t," she explains. "Yes, we like to do surgery and fix patients, but unless you can talk to a patient about their problems you can’t fix the problem. For some of the longer-term conditions, you need to know what’s hurting the patient, what their goals are, what you want to improve. You really can’t find out their goals and make them better if you can’t communicate with them."

According to Dr. Templeton, the Bayer course was "excellent and much more" than she anticipated. "What I learned the most wasn’t just how to communicate with patients, but how to observe others do it and how to help others do it better," she says.

As a mentor, Dr. Templeton plans to utilize her connections well. She says she "has great outreach ability" as president of the Kansas Orthopaedic Society, member of the Board of Directors of the Ruth Jackson Society and president-elect of the Mid-Central States Orthopaedic Society."Although I will work with practicing orthopaedists, my main focus will be to work with residents before they get set in their ways," says Dr. Templeton.

Dr. Sarwark, a pediatric orthopaedic surgeon at Children’s Memorial Hospital in Chicago, is also enthusiastic about what he learned. He plans to mentor at state and regional orthopaedic societies, the Academy’s Instructional Course Lectures and at the pediatric hospital where he practices.

"Patient-physician communications means getting to the essence of the encounter, meeting needs and communicating clearly and empathetically," says Dr. Sarwark. "Communicating with parents and teens is essential in pediatrics. What I learned from the Bayer workshop was that many of us physicians interrupt too soon and too frequently. And we think we educate our patients much more than we really do."According to Dr. Goldstein, Bayer is particularly impressed with AAOS’s establishment of "a critical mass of AAOS mentors" to serve as faculty leaders to champion this effort. "This will ensure the program’s education efforts reach a substantial portion of AAOS members," he says. "It will also increase the likelihood that skill changes are sustained and supported over time."

Prior to the Bayer’s June faculty course, the newly developed orthopaedic-specific video vignettes were field-tested by four faculty members and 10 residents at the Oregon Health Sciences University (OHSU) on June 9. Dr. Tongue led the first orthopaedic-specific 4 1/2-hour pilot workshop, along with Laurence H. Baker, PhD, Bayer’s Western Regional Consultant, and a clinical psychologist. Based on the attendees’ feedback, slight edits were given prior to Bayer faculty, which were implemented in the June faculty course the following week.

Although Ali R. Motamedi, MD, an OHSU faculty member, took some communication courses in medical school, he learned new dialogue on how to close the visit. "For example, we could say to the patient, ‘So, we’ve covered a lot of issues related to your injury. What’s the most important thing in your mind?’" he explains. "Essentially you’re giving patients an opportunity to explain in their own words what is important to their care so they know they’re understood."

Baker says it’s an exciting time for doctors to be taught by other doctors. "These doctors have increased empathy and enhanced knowledge of the challenges they face regarding clinical and communication dilemmas that are inherent to the practice of orthopaedics," he says. "Orthopaedic surgery has had a history of demanding great depth of scientific knowledge and surgical skills. So, doctors understandably have been selectively focused on the scientific aspect of medical care. Fortunately, we’re seeing more emphasis in medical school on the communication process."

But can old dogs be taught new communication tricks?

Charles B. Bird, MD, professor and chairman of OHSU’s Department of Orthopaedics and Rehabilitation, who attended the pilot workshop, believes they can."Yes, orthopaedists can learn new tricks if they want to—and if they listen," says Dr. Bird. "If we can present them with the tools to work with, then perhaps they will. We need to know that as an Academy, we can change old habits positively. My suspicion is we’re going to find some very good people who will [change] and others who won’t change.

"For those who will be able to incorporate this communications training, they’ll find that their practice will be less stressful because they’ll have fewer problems with their patients understanding of just what they’re trying to help them with."

Dr. Bird also believes the workshop had "good value" for the OHSU orthopaedic department. "From the standpoint of taking part in the Academy activities, the workshop strengthens our ties to the Academy and impresses upon the residents the importance of the Academy to the profession," he says.

Ideally, Dr. Tongue says the Academy’s initial goal is to teach 100 workshops by the end of the year 2003. The next Bayer faculty course to train mentors will be held on Nov. 4-9, 2001. There will be more opportunities next year for two more groups of six orthopaedists to attend.

"We don’t want to give anyone the impression that we’re up and running," says Dr. Tongue. "We don’t have all the teachers yet. What’s key here, initially, is that the mentors will schedule groups of residents and practicing orthopaedists at state and regional meetings for workshops."

For those interested in learning better communication skills, the workshop will be taught as an Instructional Course Lecture at the 2002 Annual Meeting in Dallas; however, only a limited number of spaces are available.

Academy members who are interested in becoming mentors should submit an application via e-mail to Charmain Rachal (rachal@aaos.org) at the Academy office or call 800-346-2267, ext. 4101.


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