UIC trains future nurses, physicians to communicate with care

After just a few moments into their health care appointment, patients are often interrupted by their providers.

"Oftentimes, patients never get the chance to tell their story," said Leah Burt, a nurse practitioner and clinical assistant professor at the UIC College of Nursing. "I'd like to change that."

This year, Burt put the final touches on Sim-Comfort, a simulation-based assessment instrument to boost nursing and medical students' person-centered communication skills. The method, which relies on assessment and feedback from professional actors portraying patients, was developed in collaboration with health care professionals and communication scholars.

"You can't assess communication with a checklist," Burt said. "That's too sterile. It's up to educators to think outside the box and elevate how students connect with patients. You don't make strides forward without shaking things up a little bit."

Burt's method leverages UIC's roster of standardized patients: actors who realistically portray patients so health care students can practice procedures and diagnoses. She said current simulations don't comprehensively assess relational communication, a core competency for nursing and medical students.

"And by communication, I don't just mean, 'Did the provider say this or ask about that?'" Burt said. "We're looking for person-first, relational connections that prioritize patients' physical, social, emotional, spiritual and even family needs."

Here's how it works: The actors, portraying patients with specific conditions like diabetes or COPD, give specific, constructive feedback to medical students by following an assessment instrument of 17 behaviors that the studen t must demonstrate. For example, did the student demonstrate deep listening strategies and acknowledge stressors? Standardized patients can rate the students on each item and provide feedback about their experiences receiving care.

Burt's model is adapted from a communication framework to train nurses created by Joy Goldsmith and Elaine Wittenberg from the COMFORT Communication Project.

"We cold-called (Goldsmith and Wittenberg) because their model was so theoretically grounded, and we loved it. We were delighted that they agreed to collaborate and help us expand their method for all health care providers," Burt said. Goldsmith and Wittenberg worked closely with the UIC team on Sim-Comfort.

To refine Sim-Comfort, the researchers paired standardized patient actors with six health care student "providers." The students had to perform a patient interview and communicate a treatment plan.

Afterward, both parties analyzed the Sim-Comfort assessment, noting items that were missing, confusing or unnecessary.

"We made significant revisions based on feedback from our participants," Burt said. "Sim-Comfort has to be user-friendly. If it's not asking clearly assessing the correct communication behaviors, it's not going to work."

The researchers also tested for consistency among different raters evaluating the same student. Burt is satisfied with the results and plans to conduct further testing with larger, more diverse populations.

"Communication is a dynamic, complicated interaction between two people," Burt said. "I don't think it's realistic for a communication tool to achieve absolute perfection between raters, but we want it to be useful and meaningful for educators."

Jennifer Maffucci, an assistant teaching professor in the College of Nursing, incorporated Sim-Comfort into her pre-licensure nursing course, Health Assessment and Communication, last fall.

"(Sim-Comfort) is a fantastic learning experience for the students," Maffucci said. "It took a lot of preparation and planning, but it was so worth it. I was so proud of them for how well they communicated and for the empathy and compassion they displayed."

Samatha Kam, a third-year student pursuing a bachelor's degree in nursing, took Maffucci's course last fall. She said the simulation helped her practice concepts she'd learned in class.

"Working in health care has taught me that experiencing things in person can be very different from the textbook version. I'm very grateful for (Sim-Comfort) in particular, as breaking bad news can be overwhelming without prior practice. It was reassuring to see how I responded in that situation and to identify areas of improvement."

Burt anticipates implementing Sim-Comfort in UIC's nurse practitioner program soon. "It goes against the whole medical hierarchy, where the physicians and health care providers are the rulers and the patients are the followers, versus engaging with patients on an equal playing field," Burt said. "That's the kind of health care providers I want UIC to send out into the world."

Bob Kiser, interim director of the Simulation and Integrative Learning Institute and Dr. Christine Park, the former director, are coauthors on this study.