People with serious illness face many decisions, both personal and medical, that can be frightening, difficult and confusing, and they rely on their healthcare teams to clearly communicate prognosis and treatment options throughout their life. sickness. Studies have shown that patients who have conversations with their clinicians about prognosis, medical and personal goals, and treatment preferences are more likely to receive goal-consistent care and enjoy a better quality of life. . However, the John A. Hartford Foundation’s 2016 survey of physicians found that 46% of physicians say they don’t know what to say in conversations with critically ill patients, and only 29% feel they have received the training in communication needed to share difficult news, explore goals of care, and manage end-of-life decisions .
In US medical schools, training in critical illness communication (along with other essential palliative care concepts and skills) is insufficient, sporadic, and mostly optional . Besides some outstanding examples of longitudinal and integrated palliative care curricula (such as the University of Rochester  and Yale Medical School ), most American medical students learn to communicate about serious illnesses “on the fly” by observing clinicians with varying degrees of skill, and without receiving specific advice or feedback. While the Liaison Committee on Medical Education directs medical schools to teach aspects of end-of-life care, the Association of American Medical Colleges explicitly recommends palliative care training for all stages of illness, prognostic reasoning, shared decision making and communication of emerging challenges in clinical skills programs . Medical schools face competing demands and most lack the strategies and resources to integrate critical illness communication training into their required longitudinal curriculum, despite the National Expert Consensus Competencies published in 2014 that have “raised the bar” for educational standards in palliative care in undergraduate medical education. .
The slow pace of curriculum reform in medical schools may be linked to their traditional organizational hierarchies, often constrained by resources and accreditation guidelines. In business literature, organizational change expert John Kotter describes the strategy of a “dual operating system” or network of dynamic volunteers who work within and alongside traditional hierarchies to execute a shared vision of change. institutional change. . This collaborative approach can accelerate organizational change via an engine of peer support and collective expertise to drive innovation with shared results.
In this report, we describe the creation of a statewide collaboration among faculty, administrators, and students within and alongside four medical schools to promote critical illness communication skills. as essential and required for all future physicians.
Note that this approach is applicable to any area of curriculum reform. In 2015, our schools came together to address the prescription opioid epidemic at the request of the state governor and developed shared educational skills on safer opioid prescribing and diagnosis and treatment. substance use disorders to guide undergraduate teaching. . In this report, we go beyond an educational skills strategy and describe our efforts to build a lasting collaboration to close another gap – critical illness communication training – for all students. We share our first steps in defining our mission, scope of work, and teaching skills, which set the stage for curriculum mapping, innovative instructional design, and faculty development as next steps.