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Introduction

I'll be lucky if I graduate with a kernel of empathy left.

 —NEUROSURGERY CHIEF RESIDENT

We hope you've started to envision how the facilitation techniques we've presented can enhance the facilitation that you are already doing, or will hopefully be doing soon. Although there has been a lot of research on the training of medical students and residents, it is less certain whether these strategies and approaches translate into the world of practicing clinicians, attending physicians in particular. Often, we assume they do. In our experience, we developed different approaches for them that helped us tailor our training to their needs. In this chapter, we will discuss communication training for residents and fellows and highlight areas of consideration when facilitating for this group.

The Case for Similarity

Medical students and residents become staff physicians, so the internal motivations and training framework are similar. Resident and fellow (trainee) training in communication appears to be the same as teaching attending physicians in the following ways:

  • The foundational skills for relationship building are the same.

  • The themes for communication challenges are the same.

  • Both often think they do a pretty good job of communicating with patients already.

  • Both are scientists who critically evaluate evidence.

  • Their time is valuable.

  • They bring their own values and experiences to bear.

  • Both feel vulnerable when their communication skills are criticized.

  • Neither group becomes better communicators by listening to lectures on how to communicate.

  • Both frequently evolve in a deficit-based culture.

The Case for Differences

We already know that empathy declines in medical school and residency as pressures escalate during training. Not only does it decline, it doesn't recover until late in one's medical career. Efforts to better understand the environment of our medical students and residents offer several reflections about what is different for these populations:

  • Trainees are much more likely to have had communication skills training in medical school than faculty.

  • Trainees have had less clinical time and experience with patients.

  • Trainees have basic needs that aren't necessarily met (sleep, food, etc.).

  • Trainees are at a different stage of life, both personally and professionally.

  • Attendings have the final say in the plan of care; trainees don't.

  • Trainees are expected to teach each other.

  • Because they are lower on the medical hierarchy (with less power), trainees may be made to feel as though their opinions will not be taken into consideration.

  • An attending facilitator may be perceived as an adversary rather than a peer.

  • Trainees are still in learning mode and therefore seem excited to be challenged intellectually.

Resident and Fellow Communication Training: Current State

While recently facilitating a group of nine residents, we noted that all of the residents had had some form of communication training; at least half ...

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