Article

The Palliative Care Clinical Evaluation Exercise (CEX): An Experience-Based Intervention for Teaching End-of-Life Communication Skills

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Academic Medicine (Impact Factor: 3.47). 07/2005; 80(7):669-76. DOI: 10.1097/00001888-200507000-00009
Source: PubMed

ABSTRACT To pilot test the "Palliative Care Clinical Evaluation Exercise (CEX)," a new experience-based intervention to teach communication skills in giving bad news and discussing code status. The intervention allows faculty to observe, evaluate, and give feedback to housestaff in their discussions with patients and families.
In 2002-03, the intervention was piloted among 60 first-year residents in the categorical Internal Medicine Residency Programs at the University of Pittsburgh. The authors collected feasibility measurements at the time of intervention, and interns' attitudes were measured before and one week after intervention and at the end of the intern year.
Forty-four residents (73%) completed the intervention. Discussions averaged a total of 49.5 minutes (SD 24.1), divided among 12.7 minutes (SD 7.5) for prediscussion counseling between the resident and faculty observer, 25.6 minutes (SD 16.1) for the resident-patient discussion, and 12.1 minutes (SD 5.7) for postdiscussion feedback. Residents rated the Palliative Care CEX favorably (>3 on a five-point scale) on ease of arranging the exercise, educational value, quality of the experience, effect on their comfort with discussions, importance to their education, and value of preceptor feedback. Self-ratings of communication competence showed improvement one week after the intervention.
The Palliative Care CEX is feasible and positively valued by residents. The findings from this initial pilot study support the value of further efforts to refine the intervention, to confirm its feasibility in other settings, and to validate its use as an educational and assessment tool.

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    • "yes resident questionnaires (telephone survey and written questionnaire) (Han et al., 2005) most residents rated the Palliative Care CEX very highly (>4 on five-point scale) among several dimensions: -educational value, -overall quality of the experience, -preceptor " s effectiveness in creating a positive learning experience, -improvement in comfort with discussions, -importance of formal instruction in end-of-life communication, -value of preceptor feedback). the study provides support for the feasibility in this setting. "
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    • "Most assess trainees' history-taking, physical examination, and communication or counseling skills, and many include multiple skill domains. Some tools focus on more specific clinical skills, such as palliative care or cardiac auscultation (Han et al. 2005; Torre et al. 2005). Most tools employ numerical rating scales supported by adjectives/ adverb anchors. "
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    • "The hallmark of palliative end of life care is holistic, relationship-centered, and compassionate care of people living and dying with life-threatening conditions and their families. A number of curricula (Bednash & Ferrell, 2000; Emanuel et al., 2002; Back et al., 2003; Liao et al., 2004; Browning & Solomon, 2005; Ferrell et al., 2005; Han et al., 2005; Ogle et al., 2005; Sullivan et al., 2005; Paice et al., 2006; Kelly et al., 2008) using different teaching methods (Williams et al., 2001; Browning & Solomon, 2005; Fryer-Edwards et al., 2006; Ferrell et al., 2007; Weissman et al., 2007; Meyer et al., 2009) have been developed to give health care professionals the knowledge and skills to care for dying people. "
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