A Standardized Patient Model to Teach and Assess Professionalism and Communication Skills: The Effect of Personality Type on Performance

doi:10.1016/j.jsurg.2013.09.010

Journal of Surgical Education

Volume 71, Issue 3, May–June 2014, Pages 297-301

https://doi.org/10.1016/j.jsurg.2013.09.010 Get rights and content

Introduction

Teaching and assessing professionalism and interpersonal communication skills can be more difficult for surgical residency programs than teaching medical knowledge or patient care, for which many structured educational curricula and assessment tools exist. Residents often learn these skills indirectly, by observing the behavior of their attendings when communicating with patients and colleagues. The purpose of this study was to assess the results of an educational curriculum we created to teach and assess our residents in professionalism and communication.

Methods

We assessed resident and faculty prior education in delivering bad news to patients. Residents then participated in a standardized patient (SP) encounter to deliver bad news to a patient’s family regarding a severe burn injury. Residents received feedback from the encounter and participated in an education curriculum on communication skills and professionalism. As a part of this curriculum, residents underwent assessment of communication style using the Myers-Briggs type inventory. The residents then participated in a second SP encounter discussing a severe pulmonary embolus with a patient’s family.

Results

Resident performance on the SP evaluation correlated with an increased comfort in delivering bad news. Comfort in delivering bad news did not correlate with the amount of prior education on the topic for either residents or attendings. Most of our residents demonstrated an intuitive thinking style (NT) on the Myers-Briggs type inventory, very different from population norms.

Discussion

The lack of correlation between comfort in delivering bad news and prior education on the subject may indicate the difficulty in imparting communication and professionalism skills to residents effectively. Understanding communication style differences between our residents and the general population can help us teach professionalism and communication skills more effectively. With the next accreditation system, residency programs would need to demonstrate that residents are acquiring these skills in their training. SP encounters are effective in teaching and assessing these skills.

Introduction

Professionalism and interpersonal communication are 2 of the 6 core competencies as required by the Accreditation Council for Graduate Medical Education for all specialties.¹ Unlike medical knowledge and patient care, which can be reliably measured with in-training examinations and objective standard clinical examinations,² education and assessment of professionalism and communication skills is more difficult to do.³

Professionalism is often taught in a nonformal manner, commonly referred to as the “hidden curriculum,” where residents learn professionalism by observing how their attendings behave in the clinical setting.⁴ More structured techniques for education in professionalism have been shown to be more effective than the passive “hidden curriculum.”⁵ To address this need for education in professionalism and interpersonal communication skills, residency programs have developed more formal curricula to teach their trainees these skills, including some that use standardized patients (SPs) for this purpose.

The principle situation in which surgeons demonstrate professionalism is in communication. The importance of effective communication can have a direct effect on patient care and outcomes. Better patient communication can improve not only comfort and satisfaction,⁶ but it can also decrease the frequency of legal action even in the setting of a poor outcome.7, 8 Many authors have designed curricula to teach these critical skills, and the results have been encouraging.9, 10

In the present study, the authors developed a SP module to teach and assess our residents’ skills in professionalism and interpersonal communication competencies. The purpose of this study was to assess the skills of plastic surgery residents in professionalism in a SP encounter of delivering bad news to the patient’s family members.

Section snippets

Methods

Residents were surveyed for their prior education in communicating bad news to patients. We adapted the Orgel questionnaire¹¹ to assess residents’ comfort in delivering bad news and self-rated ability to do so. Faculty also completed this questionnaire.

All postgraduate-2 and higher residents in our training program participated in a SP encounter at the start of this module. In this scenario, residents were speaking to the family of a child who sustained burns on 80% of total body surface area,

Results

Overall, 17 residents completed the questionnaire on prior education in delivering bad news and participated in the SP sessions (Table); while 23 faculty members completed the questionnaire.

Self-reported comfort in delivering bad news did not correlate with the number of previous education sessions on delivering bad news that they had received. This was true for both residents and faculty. The mean comfort level of residents who received up to 10 sessions (including 2 residents who reported

Discussion

With the next accreditation system scheduled to go live for some surgical specialties (neurosurgery, orthopedics, and urology) in 2013 and the remainder in 2014, programs would need to demonstrate that they are educating their residents in professionalism and interpersonal communication and demonstrate their residents’ proficiency in these competencies more concretely than they have in the past. In plastic surgery, 36 milestones have been developed to track the progress of a resident through

Acknowledgment

The authors would like to thank Linda Dillon Jones, PhD, for her assistance with administration and interpretation of the MBTI.

References (20)

R.M. Antiel et al.
Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors
Mayo Clin Proc
(2011)
C. Iramaneerat
Instruction and assessment of professionalism for surgery residents
J Surg Educ
(2009)
M.S. Hochberg et al.
Can professionalism be taught? Encouraging evidence
Am J Surg
(2010)
P. Deptula et al.
A literature review of professionalism in surgical education: suggested components for development of a curriculum
J Surg Educ
(2013)
G. Posner et al.
Assessing residents’ communication skills: disclosure of an adverse event to a standardized patient
J Obstet Gynaecol Can
(2011)
G. Cousin et al.
Concordance between physician communication style and patient attitudes predicts patient satisfaction
Patient Educ Couns
(2012)
J. Son et al.
Teaching core competencies of reconstructive microsurgery with the use of standardized patients
Ann Plast Surg
(2013)
A.B. Symons et al.
A tool for self-assessment of communication skills and professionalism in residents
BMC Med Educ
(2009)
W. Gofton et al.
What we don’t know we are teaching: unveiling the hidden curriculum
Clin Orthop Relat Res
(2006)
M.A. Stewart
Effective physician-patient communication and health outcomes: a review
CMAJ
(1995)

There are more references available in the full text version of this article.

Cited by (14)

Pilot study to identify attributes of professionalism in sonography
2021, Radiography
Citation Excerpt :
All professional attributes identified in the Phase 1 focus groups had previously been used to define professionalism for other medical and healthcare professions, except for ‘Personality.’ However, ‘personality’ has been mentioned in recent nursing18 and medicine articles,19 suggesting that personality may impact on professionalism and communication skills. This was echoed by experiences of sonographers in Phase 1, who thought that the profession of sonography may be more suited to specific personality types.
While a list of competency standards exists for sonographers, the profession does not have a specific statement concerning professionalism. What constitutes professionalism within sonography is important and needs to be considered from the perspective of all stakeholders. This paper reports the results of the first two exploratory phases of a larger study investigating professionalism in sonography.
Phase 1 involved interviews with experienced and early-career sonographers to identify attributes of professionalism within the context of sonography. Attributes identified in phase 1 were used to frame survey questions for phase 2. In phase 2, sonography patients were asked to rate the attributes using Likert-type responses, and to provide additional comments at the end of each category. Patients had the opportunity to add attributes not mentioned in the survey.
Content analysis of Phase 1 interview data identified 27 professional attributes organised into seven categories. Phase 2 results indicated that only a few attributes were rated as not important or not applicable by patients. Highest-rating attributes by patients included verbal communication, patient privacy, trust, behaviour, empathy, and respect. Attributes that were not rated as highly included rapport, physical presentation, dedication to learning and improving oneself, personality, and role model.
Due to the complexities around a clear definition of professionalism within the context of sonography, this study has highlighted the need for a comprehensive list of attributes to identify what professionalism in sonography means.
Having a clear understanding of the concept of professionalism within the context of sonography will provide a guide for sonographers and sonography students, and enable academic and on-site clinical trainers to explicitly teach what professionalism looks like and feels like in sonography practice.
Training Surgical Residents to Communicate with Their Patients: A Scoping Review of the Literature
2021, Journal of Surgical Education
Effective communication is critical in surgical practice and the Accreditation Council on Graduate Medical Education requires a focus on interpersonal and communication skills. Absent a national communication skills curriculum for surgical residents, individual programs have designed and implemented their own curricula. This scoping review explores communication training in North American surgical residency programs.
The review was conducted according to PRISMA guidelines, and included articles identified through searches of 6 publication databases conducted on June 25, 2019 and updated on April 2, 2020. Eligible studies described patient or family communication skills education for surgical residents in North America. Published abstracts were excluded. Article abstracts were screened by 2 reviewers. For articles meeting criteria, data on study setting, participants, curriculum design, educational techniques, and skills focus were extracted and analyzed.
A total of 2724 articles were identified after removing duplicates; 84 articles were reviewed in full text. Thirty-three met study criteria including 4 from 2006 to 2009 and 29 after 2010. The most common skills education focused on breaking bad news, followed by a range of topics, such as empathy, end of life and/or palliative care discussions, medical error disclosure, shared decision making, and informed consent. Some of the training was part of larger curriculum including team training or professionalism. Over half of the studies involved general surgery learners. The most common form of education included didactics followed by practice with peers or simulated patients. Only half of the programs described curricula involving multiple training sessions which is important for ongoing development and skill reinforcement.
Effective communication skills are important, necessary, and increasingly incorporated into surgical training programs. While the literature is expanding, few surgical residency programs have described communication curricula. This review serves as a guide for programs interested in developing their own communication curricula for surgical residents.
Myers-Briggs Type Indicator in Medical Education: A Narrative Review and Analysis
2020, Health Professions Education
Health professionals are moving beyond traditional roles as vessels of science and are expected to exhibit excellence in psychosocial sciences, communication, and humanities. Medical education has shifted focus to non-cognitive aspects of training, which have been correlated with clinical performance, professionalism, interpersonal skills, and in-service exam scores. Psychometric tests are a means to gauge an individual's personality and behavioral characteristics. They have been used in various professional settings. The Myers-Briggs Type Indicator (MBTI) is an introspective psychometric questionnaire explaining an individual's decision-making, perception, and interactions. Medicine has used the MBTI by surveying providers and trainees. Particular interest is paid to its use in medical education. This review aims to provide a comprehensive review and analysis of MBTI use in medical education.
A PubMed search (1975–2018) was performed to identify studies addressing MBTI in medical education using a combination of Boolean and MeSH search terms. Forty articles were included in the final review.
Overall, 30% (12/40) of articles addressed MBTI in specialty/training setting selection, 52.5% (21/40) addressed MBTI in medical curricula, and 17.5% (7/40) addressed MBTI in evaluation/selection of trainees. MBTI preferences of different specialties showed inconsistencies. MBTI improves trainee communication skills, identifies those at risk for burnout, directs use of personalized study resources, among other domains. Biases in medical school and residency admissions processes are unearthed with MBTI. Furthermore, certain MBTI traits show stronger correlation with trainee clinical evaluations than board exam scores.
MBTI is a potentially powerful tool for medical education. However, a large portion of studies (30%) investigate its role in specialty choice, a domain with inconsistent results. Instead, MBTI may be better served to provide trainees with individualized study environments/resources, enhance communication skills, and provide burnout screening and support. Furthermore, it may address biases in the subjective medical school and residency interview processes and increase class psychodynamic diversity. New era problem-based learning and team-based learning may be enhanced with MBTI. In these ways, the application and interpretation of this psychometric tool may advance personalized medical education in the 21st century.
Incorporation of Personality Typing into a Neurologic Surgery Residency Program: Utility in Systems Based Practice, Professionalism, and Self-Reflection
2018, World Neurosurgery
Citation Excerpt :
Often times, personality traits that are extremely adaptive in some situations can be maladaptive in others. The Myers–Briggs Type Indicator (MBTI) has been used extensively in the business and administrative world and more recently also studied in medicine with regard to selection of specialty,1-14 perspectives on the various specialties,15-18 and offering insights into how various types learn in different contexts.18-23 As a quality improvement effort to promote self-reflection and personal and professional improvement among both faculty and residents members in a department of neurosurgery at a tertiary care academic medical center, a group learning exercise was implemented using the MBPT.
In the neurosurgery residency, inherent personality traits can play a significant role in the adaptability and success of the resident physician.
The Myers–Briggs Type Indicator has been used extensively in the business and administrative world. As a quality improvement effort to promote self-reflection, personal and professional improvement among both faculty and resident members of a department of neurosurgery at a tertiary care academic medical center, a group learning exercise was implemented using the Myers–Briggs Type Indicator.
All residents (11/11) and 85% of faculty (11/13) participated in the exercise. INTJ ("Mastermind," "Scientist") was the most commonly represented (36.4% compared with 2.1% in the general population; P < 0.001). ENTJ ("Field Marshall," "Executive") was present in 18% compared with 1.8% of the general population (P < 0.001). Thus, the 2 most common types (_NTJ) were present in 54.4% of our department compared with 3.9% of the general population (P < 0.001).
Personality typing can be used to gain valuable insight into the composition of neurosurgery residency cohorts and resolve conflicts arising from personality differences within these groups as well as within the larger hospital setting.
Mixed-Method Evaluation of a Cadaver Dissection Course for General Surgery Interns: An Innovative Approach for Filling the Gap Between Gross Anatomy and the Operating Room
2018, Journal of Surgical Education
Citation Excerpt :
According to a study by Swanson et al.,45 most current surgical trainees demonstrated significantly different personality types from their faculty teachers, who were trained under the apprenticeship model of residency. The apprenticeship format of our course may reduce this discrepancy and improve learning efficacy via matching the student’s personality type and learning preferences to the teacher’s methodologies through gradual mutual understanding.46,47 The resource-intensive nature of cadaver dissection courses have frequently been commented on in the literature48 and is one of the main factors for its decline in popularity in the recent years.36,49
To evaluate an innovative whole cadaver dissection curriculum designed to focus on teaching procedure-relevant anatomy and surgical skills to surgery interns.
A mixed methods explanatory sequential design incorporating both quantitative and qualitative evaluations was used to evaluate the cadaver dissection course. Quantitative data were prospectively collected and retrospectively reviewed in order to compare anatomy knowledge and operative skills before and after the course. In the qualitative phase, open-ended telephone interviews were conducted in order to explore the major strengths and weaknesses of the course and gain a more in-depth understanding of resident perceptions and attitudes toward the course.
All UCLA categorical surgery interns who have undergone the cadaver dissection curriculum between the years 2010 to 2016 were recruited for evaluation and interview.
From 2010 to 2016, 6 to 7 categorical surgery interns were enrolled in the cadaver dissection course each year.
Anatomy practical examination scores increased following implementation of the course from 50.5% to 83.5% (p < 0.01). Faculty ratings of operative skills improved as well (average Likert scale rating for technical skills improved from 4.1 ± 0.4 to 4.4 ± 0.3, p = 0.06). Almost all interviewees (96%) reported that the course improved their knowledge of anatomy, and 78% of respondents believed the course was conducive to improving technical skills.
We believe that cadaver dissection courses offer a superior educational model for teaching clinically relevant anatomy as well as surgical skills. We found improvements in anatomy knowledge and technical skills, and trainees expressed strongly favorable views of the program.
An Informed Consent Program Enhances Surgery Resident Education
2017, Journal of Surgical Education
Citation Excerpt :
One of the greatest strengths of our educational program is the inclusion of a simulated informed consent process using standardized patients (SPs) to underscore the importance of communication. Numerous studies demonstrate that the use of SPs is an effective way to teach communication skills to both residents and medical students.21-26 Whereas our study aimed to assess resident-reported comfort and not ability as assessed by the SP, several other studies have shown that surgical residents who received feedback from SPs scored higher on subsequent communication exercises compared with those who did not receive feedback.23,24,27
First-year residents often obtain informed consent from patients. However, they typically receive no formal training in this area before residency. We wished to determine whether an educational program would improve residents’ comfort with this process.
Our institution created an informed consent educational program, which included a didactic component, a role-play about informed consent, and a simulation exercise using standardized patients. Residents completed surveys before and after the intervention, and responses to survey questions were compared using the signed-rank test.
This study took place at Temple University Hospital, a tertiary care institution in Philadelphia, PA.
First-year surgery and emergency medicine residents at Temple University Hospital in 2014 participated in this study. Thirty-two residents completed the preintervention survey and 27 residents completed the educational program and postintervention survey.
Only 37.5% had ever received formal training in informed consent before residency. After participating in the educational program, residents were significantly more confident that they could correctly describe the process of informed consent, properly fill out a procedure consent form, and properly obtain informed consent from a patient. Their comfort level in obtaining informed consent significantly increased. They found the educational program to be very effective in improving their knowledge and comfort level in obtaining informed consent. In all, 100% (N = 27) of residents said they would recommend the use of the program with other first-year residents.
Residents became more confident in their ability to obtain informed consent after participating in an educational program that included didactic, role-play, and patient simulation elements.

View all citing articles on Scopus

View full text

Original reportsA Standardized Patient Model to Teach and Assess Professionalism and Communication Skills: The Effect of Personality Type on Performance

Introduction

Methods

Results

Discussion

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgment

Mayo Clin Proc

J Surg Educ

Am J Surg

J Surg Educ

J Obstet Gynaecol Can

Patient Educ Couns

Teaching core competencies of reconstructive microsurgery with the use of standardized patients

Ann Plast Surg

A tool for self-assessment of communication skills and professionalism in residents

BMC Med Educ

What we don’t know we are teaching: unveiling the hidden curriculum

Clin Orthop Relat Res

Effective physician-patient communication and health outcomes: a review

CMAJ

Original reports
A Standardized Patient Model to Teach and Assess Professionalism and Communication Skills: The Effect of Personality Type on Performance