Poster2 - 02: A NEEDS ANALYSIS TO INFORM AN AWAKE SURGERY COMMUNICATION CURRICULUM: THE RESIDENT PERSPECTIVE
Robert C Nolan1, Claire Smith1, Nancy Schindler, MD, MHPE2; 1University of Chicago Pritzker School of Medicine, 2University of Chicago Medicine
Purpose: Surgeons are increasingly performing procedures on awake patients, which offer shorter recovery times and decreased costs. However, such procedures present significant challenge in a training environment. Attending surgeons must balance coaching and instruction with the emotional and physical comfort of the listening patient. Recently patient experience has emerged as both a measure of quality and an influence on reimbursement. This study extends previous efforts to understand best practices in the awake surgery environment, adding the resident perspective. The eventual goal is developing a curriculum to teach best practice for communication in this environment.
Methods: With IRB approval, we performed a qualitative study utilizing semi-structured focus groups of 2-7 residents from three surgical specialties (OB-GYN, General Surgery, Urology) who had participated in ten or more conscious surgical procedures. Questions focused on prior training and communication successes and failures during awake surgery.
Transcripts were de-identified, and using the constant comparative method, themes were collapsed and expanded in an iterative process until three researchers confirmed themes accurately represented the data.
Results: 25 residents participated in 5 focus groups, after which saturation was reached.
Themes included challenges and benefits to conscious procedure, patient-communication successes and failures, and positive and negative education techniques. Frequently cited communication success included pre-operative communication, a patient-oriented strategy, intra-procedure distraction, patient education, and preparation for noticeable changes. Communication failures including over-assurance, forcing forward progress, quiet procedures, and inappropriate humor.
No residents reported current curriculum covering communication in the setting of conscious procedure; however, four of five focus groups expressed interest.
Conclusion: A strong correlation was identified between resident and attending perspectives on positive communication techniques, with 67% of subthemes identified within resident focus groups correlating directly to themes identified with prior attending physician data.
The residents’ unique perspective as the learner in this operating theatre yielded some new themes including the doctor-patient relationship, professionalism, and positive reinforcement for the patient.
Having completed this exploratory qualitative study, the next step will be to survey a larger cohort of patients to confirm findings are generalizable, and then to develop a curriculum to teach best practice strategies for communicating during awake surgery.