Background:
Patient-centered communication is essential to care for individuals with cancer. High
quality communication benefits patients, families, and clinicians. Proficiency in a
variety of communication tasks is now a requirement within competency-based medical
education (CBME) in Canada. Within oncology training programs, communication training is
mostly unstructured observation and feedback in the clinic and many learners receive
inadequate training. A formal communication curriculum could fill a gap and help to
standardize teaching and evaluation, but current resources are limited.
Virtual care has been quickly adopted within oncology practice in the context of the
COVID19 pandemic. This limits opportunities for direct observation of learners making
assessment of communication skills more difficult. How best to teach communication skills
in the context of virtual care is unclear. To mitigate current challenges, we will adapt
two recognized educational tools, electronic learning modules (ELMs) and standardized
patients (SPs), to create a novel virtual training strategy. Typically, SP skills
sessions occur in person and effectiveness of SP encounters in a virtual care context has
not been evaluated. Moreover, it is uncertain whether SPs are necessary for creation of
psychological fidelity or improvement of transfer of communication skills. Thus, we aim
to explore the relative impact of each component of a virtual communication curriculum.
In this study, we will explore the feasibility of a randomized controlled trial comparing
different training experiences.
Methods:
ELMs will be developed to teach communication skills for difficult conversations in
oncology care. A framework for patient-centered communication and specific communication
strategies will be introduced. Scenarios will be developed for virtual SP encounters
related to each ELM. Virtual SP encounters will occur through the Zoom platform and
include feedback from a remote faculty observer.
A randomized feasibility trial will be conducted. Consenting medical and radiation
oncology residents in participating training programs (McMaster, University of Ottawa,
University of Toronto) will be randomly assigned to complete the ELMs and virtual SP
encounters (experimental arm) vs the ELMs alone (control arm). Video recorded simulated
patient encounters will be conducted before and after the curricular activities.
Recordings will be scored by trained assessors with multiple rating scales to evaluate
communication skills of the learner. Standardized patients will also rate quality of
physician communication with a patient-directed rating scale. This design will allow
testing of our innovative educational interventions and exploration of the likelihood of
success of a future RCT which will evaluate the impact of different training experiences.
Outcome measures will include feasibility metrics such as recruitment, randomization,
representativeness, adherence to intervention, and completeness of data collection. We
will determine variance in scores on multiple rating scales within this study population
to inform sample size of a future RCT. In addition, surveys completed pre- and
post-intervention will assess change in self-efficacy rating and satisfaction with the
learning experience.
Analysis:
The proposed sample size is 40 (20 per arm). This is based on achieving a 95% confidence
interval (CI) of 60 to 85% around an estimated recruitment proportion of 75%. The primary
outcome will be whether feasibility metrics meet criteria for success. Descriptive
statistics with corresponding 95% CIs will summarize recruitment, adherence to study
procedures, satisfaction and self-efficacy rating. For assessment of video recorded
virtual simulated patient encounters, correlations between scores from different rating
scales will be performed using Pearson's coefficient. Inter-rater reliability for rating
scales will be done using Cohen's Kappa.
Conclusions:
If criteria for success are met among feasibility outcomes, a national RCT will follow to
evaluate impact of virtual SPs added to the ELM curriculum. These novel educational
resources simulate virtual care, a new paradigm that will likely persist beyond the
pandemic. This is a scalable intervention which may standardize and strengthen
communication training among oncology residency programs across Canada.
