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Case Study: PRI Improves Physician-Patient Relations with Simulations
December 09, 2009
By Sarah Boehle
After state regulatory requirements changed, mandating that New York-based physicians complete risk-management training to maintain "excess levels" of medical malpractice insurance, Roslyn, NY-based Physicians Reciprocal Insurers (PRI) recognized a golden opportunity to differentiate itself from the competition and to enhance the quality of patient-physician relationships.
"One of our missions was to take our existing online learning content to another level," says Gerri Donohue, associate director of risk management education at PRI, a provider of professional liability insurance to physicians and medical facilities throughout New York State. "We wanted to create an advanced, experiential online course that would touch on all of the things doctors see in various forms from day to day while ensuring we were subtly helping them to make connections for themselves at a higher level. We also wanted a tool that would do a better job of assessing the quality of physicians' interactions with patients by placing them in situations where it wouldn't be as easy for them to determine the correct answers."
To accomplish these goals, PRI partnered with Enspire Learning in Austin, TX, to create a simulation- based course that allows physicians to learn and practice their communications skills within a safe environment. The course includes several scenarios based on real-life medical malpractice suits. In each scenario, learners review patient files, discuss patient concerns, and choose effective communication options while participating in a "branching" conversation simulation. During these conversations, patients' moods fluctuate as a direct result of a physician's choices. When the conversation ends, each learner is provided with a score, as well as extensive performance feedback, so he can fully understand the impact of his choices and learn from his mistakes.
In one such scenario, a patient named Mr. Tanaka complains of fatigue and diarrhea. The learner asks Mr. Tanaka to provide her with details regarding the pain he is experiencing and asks the patient why he thinks he might be feeling this way. After a brief discussion, the physician suggests the patient have a rectal exam—a procedure Mr. Tanaka is uncomfortable discussing. During this conversation, the learner must delicately broach the subject, being careful not to alarm the patient by jumping to the conclusion that he may have cancer or to give false hope that the patient's situation is not potentially serious (thereby opening the door to potential future litigation).
"One of the things physicians may be tempted to say to an anxious patient in situations such as these is, 'Don't worry,'" says Christine Quinn, PRI's VP for risk management services. "Even though most physicians may view this response as being kind and compassionate, it is far more bonding in a patient relationship to say something such as, 'Tell me more about what you are worried about.'" This technique, she explains, allows the patient to have a more healing experience with the physician—instead of being given false hope, feeling shut down emotionally, or being told—directly or indirectly—that his concerns are somehow unwarranted.
In addition to several "branching conversation" simulations, the five-hour course—which was launched in April 2009 to approximately 4,500 physicians throughout New York state—features didactic instruction, self-reflection activities, and discussions on topics ranging from establishing rapport, understanding patient history, and ensuring continuity in the physician-patient relationship to handling difficulty, delivering bad news, and managing medical errors. During the final course project, six additional 15-minute simulations reinforce previous physician-patient scenarios by asking learners to interact with patients in ways that apply multiple learning objectives simultaneously.
Throughout the experience, learners are able to view up-to-the- minute feedback through a " communication meter" that tracks the major decision points each learner makes during the course and provides her with a running snapshot of how she is performing. "The communication meter is such a powerful feedback tool," says Donohue. "When physicians make a poor choice and see themselves going into the red (or negative) zone, they are motivated to figure out what they did wrong and to find a way get back into the green (positive) zone of the meter." To do just that, she says, learners can click on "nodes" within the meter and expand the feedback window to reveal more detailed information about the ramifications of their choices, and then redirect their approach accordingly.
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