Box 1.

Communication skills workshop curriculum: overview presentation and skills practice

SessionOverview PresentationSkills Practice with Simulated Patient and Family MemberFellow Goals for Skills Practice
Giving bad newsSkills taught: Giving information: Ask-Tell-Ask (see Box 2) Recognizing and responding to emotion:NURSE acronym (see Box 2)Background: 65-year-old man with diabetes and hypertension recently hospitalized for an elective coronary artery bypass with worsening renal function
Practice setting: Fellow meeting with patient in clinic to discuss worsening renal functionUse Ask-Tell-Ask to discuss worsening kidney function and potential dialysis preparation
Attend to patient’s emotion from hearing the news using NURSE acronym
Defining goals of careSkills taught: Use open-ended questions to elicit care goals and end-of-life preferences Respond to unrealistic goals with “wish” statementsBackground: 1 year has passed; patient is hospitalized with a large myocardial infarction and is in cardiogenic shock and life support with serum creatinine level of 5.5 mg/dl Practice setting: Fellow meeting with patient’s health care power of attorney in the intensive care waiting room to discuss goals of careElicit patient’s “big picture” goals and preferences in context of intensive care, such as dialysis
Respond to wishes for a miracle using a “wish” statement Propose a plan that fits the patient’s goals and preferences