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Introduction

 Thank goodness you didn't have a nonphysician teach this course.

 

This comment came from a participant in one of our sessions for doctors within the first year of the rollout. It's not a comment that any program or organization wants to hear, yet it wasn't uncommon. It's interesting that the term nonphysician was used, as few of us define ourselves by what they are not. How many Asian male physicians call themselves nonwhite, nonfemale non-nurses? Beyond the issue of language, it's easy to come to the conclusion that physicians think that no other professionals have the same knowledge base and experience that they do. Some physicians do feel this way, and programs that focus on relationship-centered communication rather than just physician-patient communication have a role in helping this thinking evolve. However, if we stay in a place of empathic curiosity, there are other options to explore. In an era when there is increasing emphasis on teams and interprofessional communication, the attitude that doctors are "different" feels outdated. Comments like the one above opened up a critical dialogue about how training or profession can affect perception of the course's benefits.

We've described much of our work with staff physicians because we targeted that group early on. As the program evolved, however, we made a concerted effort to integrate our training and our facilitators with advanced care providers (ACPs) and physicians. This chapter will explore our experience training ACPs in separate courses from physicians and our decision to move to more integrated courses.

The Who and Why

Our communication skills courses were initially taught separately to physicians, on the one hand, and physician assistants (PAs), nurse practitioners (NPs), and additional ACPs on the other. The physician group included MD/DOs and was taught by their peers, MD/DO facilitators. Likewise, the ACP group was also taught by their peers. The decision to group the courses in this way was an intentional one. The rationale for differentiating physician training from ACP training was based on several considerations: physicians and ACPs would feel safer practicing communication skills in front of their peers. Physicians might feel embarrassed looking less than competent in front of ACPs, and ACPs might fear disrespectful behavior from physicians. Safety is paramount, and we value it even more than the benefits of interprofessional training. Think for a minute about a scenario in which physicians object to having a nurse practitioner facilitating their course. They become vocal about the nurse practitioner not understanding their unique, daily job challenges and disengage actively from the training. The course easily can become about managing their issue, when it is really intended to strengthen the communication skills of the entire group. We wanted to make participants feel safe and supported so that they could engage in the training—and part of that safety was honoring the sacredness of the conversations physicians have with patients ...

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