Schwarze Funded to Evaluate Surgical Training Curriculum on Effective Patient Communication

In treating patients with serious illnesses and those who are near the end of life, surgeons regularly face the difficult ethical challenge of supporting patients and their families through high-stakes decision-making, such as whether to have a major surgery or whether to pursue life-supporting treatments. To help surgical trainees learn to navigate these challenging situations, a multi-institutional team of surgeon educators, led by Dr. Gretchen Schwarze in the Division of Vascular Surgery, collaborated on the development of a five-year curriculum called the Fundamentals of Communication in Surgery, or FCS. With nearly $300,000 in funding from the Josiah Macy Jr. Foundation over the next three years, Schwarze and her team will now be able to implement the FCS at 10 general surgery residency training programs across the U.S. and evaluate its impact on resident performance, determine the extent to which the curriculum can be scaled across a range of surgical training programs, and then develop a large-scale dissemination plan.

“The goal of the FCS is to prepare future surgeons to navigate treatment decisions with patients and their families,” said Schwarze. “It builds on two interventions developed and tested in my lab, Best Case/Worst Case and Better Conversations, which support surgeons when they communicate with patients and families.”

The FSC is designed to be scalable within an already-demanding residency training schedule by providing a single 2-hour session each year for the 5 years of surgical training. The sessions focus on high-impact, targeted core skills that are honed through practice and in-the-moment feedback. Sessions are tailored to the developmental stage of the learner with repetition of important concepts and incrementally more challenging clinical cases over time. The curriculum addresses three primary communication needs: helping surgeons to attend to patients’ emotions, supporting a patient’s ability to make an informed decision, and managing uncertainty.

“Surgical trainees are often confronted with decisions about surgery that are hard to navigate with patients and families because they struggle to integrate a discrete novel surgical problem within the context of other life-limiting illnesses,” said Schwarze. “Residents can also face conflict with patients and families, who are understandably distraught, which can lead to moral distress for the surgeon. We specifically designed this curriculum to provide the next generation of surgeons with the communication skills they will need to competently and confidently navigate this important ethical domain. We’re excited to evaluate the FCS at our ten pilot sites and we’re incredibly grateful to the Josiah Macy Jr. Foundation for the funding that will make this possible.”