PM2024: Residents' Attitudes on Communicating Serious News

Background: Communication with pediatric patients and their families is unique due to the triadic relationship between the patient, their caregivers, and the medical team. While both the American College of Graduate Medical Education (ACGME) and American Academy of Pediatrics (AAP) recommend incorporating communication skills into program requirements and milestones, neither endorse specific curricula or experiential learning opportunities. This results in an overreliance on informal curriculum and varied experiences for the learner that makes it difficult to draw conclusions on how best to teach and evaluate communication skills to pediatric residents. This study aims to describe the state of communication at a single-center academic institution and create recommendations for future educational opportunities.

Methods: Email queries were sent to 25 third year categorical pediatric residents and 3 third year pediatric neurology residents to participate in semi-structured Zoom interviews between August and December 2021 (IRB #211163). The recorded interview transcripts underwent thematic analysis by the same person who conducted interviewers.

The interviews all began with a prompt to discuss a time when the participants discussed serious news, which was described as news that was potentially surprising, life-altering, or that could change a patient’s clinical trajectory. The interviews also included questions on communication education and barriers to communicating serious news with patients. The interviews all concluded with the same prompt on an idealized communication curriculum during pediatric residency.

Results: Respondents included 11 categorical pediatric residents and 1 pediatric neurology resident. Eight identified as female, 4 as male. Eight indicated that they were pursuing careers that would require some outpatient clinical role, and 4 were pursuing strictly inpatient roles. Seven received formal education in medical school on giving serious news, and 10 endorsed formal communication education during residency. Seven respondents stated that observation of other physicians’ deliverance of serious news was formative to the development of their own communication style.

Per Figure 1, participants identified multiple barriers that limited their ability to lead or participate in conversations of serious news. A majority indicated that they needed to advocate for themselves to be involved in discussions that were pertinent to the care of their patients. Hierarchy or deference to a more senior doctor also prevented most participants from being able to confidently lead a discussion of serious news.

Figure 2 demonstrates factors that participants viewed as beneficial to their ability to discuss serious news with families. Nearly all wanted more opportunities with structured meetings beforehand to outline an agenda for the discussion and to receive formal feedback immediately afterward.

Conclusion: This study is limited to the experiences of residents at a single institution. Next steps include further developing formal communication education opportunities at the institution and evaluating for improvements in resident perceptions.