Surgery Faculty Receive Grant to Pilot Test Fundamentals of Communication in Surgery Curriculum

Gretchen Schwarze, MD, MPP
Amber Shada, MD

Each year 15 million Americans decide to have surgery. While these operations are largely beneficial, it’s not uncommon for patients to struggle with recalling what their surgeon told them, become overwhelmed by the experience of surgery, and endorse regret after the surgery. Similarly, surgeons express concern about a consent process that they feel leaves patients unprepared, and policymakers worry that miscommunication could lead to over-treatment. To address these issues, a multi-institutional team of surgeons, including our own Dr. Amber Shada in the Division of Minimally Invasive Surgery and Dr. Gretchen Schwarze in the Division of Vascular Surgery, collaborated on the development of a five-year curriculum for surgical trainees called the Fundamentals of Communication in Surgery, or FCS.

“Just like techniques for dissection or suturing, communication with patients about surgery is a skill that requires practice, feedback, and repetition,” said Shada. “The goal of the FCS is to drill essential communication skills into future surgeons throughout the course of their surgery residency training.”

Schwarze expanded on the background and components of the program. “The FCS builds on frameworks that support patient conversations about informed consent and serious illness, specifically Best Case/Worst Case and Better Conversations, both of which my team developed and extensively tested,” she explained. “In the FCS, residents work with partners to role-play cases where they can practice things like empathic response skills, describing the downsides of surgery in ways that patients will understand, planning with the patient for different post-surgery recovery scenarios depending on how the surgery goes, and eliciting the patient’s preferences.”

After spending the last year testing and revising the individual components of the program, the team is ready to formally pilot test the FCS in its entirety. With the support of a newly awarded $10,000 Center for Excellence in Surgical Education, Research, and Training (CESERT) Platinum Award from the Association for Surgical Education Foundation, they will now be able to do so.

The study will take place over the next two years, during which Shada and Schwarze’s research team will conduct train-the-trainer sessions at six institutions across the U.S. Once trained on the FCS, local trainers will implement it with approximately 180 general surgery residents. Using checklists and direct observations, the research team will test whether it is feasible to incorporate the FCS into general surgery residency training and whether the curriculum is acceptable to the local trainers and the residents. They will also determine how closely the trainers follow the curriculum instruction guide, how well the trainees are able to implement FCS skills into simulated conversations with patients, and how the trainee’s confidence in their clinical communication skills changes during and after completing the FCS.

“If the FCS can be implemented with fidelity to the training manual and it proves to be feasible, acceptable, and effective in our pilot study, we can then test it in a much larger scale study,” said Shada. “This curriculum is unique and it has the potential to fill a critical need in surgical education by providing residents with training in advanced techniques that could significantly benefit surgeon-patient communications. We’re excited to roll-out the pilot study and incredibly grateful for the support of the CESERT grant.”