COMSEP 2009 Baltimore Meeting with APPD
Training in Delivering an Unexpected Diagnosis
Lynn R. Campbell, MD, Harold L. Kleinert, EdD, Carol A. Lunney, PhD, James E. Ferguson, MD, MBA, University of Kentucky, Lexington, KY
This study is directed towards improving medical information and support to families as they receive the unexpected diagnosis of Down syndrome (DS).Using a Web tutorial integrating prenatal and postnatal information into virtual patient scenarios, the study assessed pediatric residents’ knowledge and comfort in delivering a diagnosis of DS. It also measured residents’ perception of need for this training. STUDY DESIGN: A team of physicians, parents, and educational specialists designed a Web-based interactive tutorial in which resident physicians read information about DS and viewed virtual patient-doctor sessions. Before and after viewing the tutorial, resident physicians were asked to respond to situations related to DS diagnoses both in utero and at the time of birth. Outcome variables included factual knowledge, attitudes about DS, and feedback about the perceived value of the tutorial as a part of residents’ curricula. Subjects included 88 pediatrics residents from 10 programs. RESULTS: The tutorial yielded significant improvement in knowledge (Pre-test Mean = 8.18, Post-test Mean = 12.00; p<.01) and a decline in the level of discomfort (Pre-test Comfort Mean = 23.13, Post-test Comfort Mean = 17.21; p<.01) that residents expressed related to counseling about DS. In addition, across all pediatric resident groups, residents strongly agreed that this type of training was beneficial for residents, for practicing physicians, and for other medical professionals (p<.03).Residents indicated that their regular curricula do not offer similar instruction in teaching communication skills that are required in clinically difficult and sensitive situations. CONCLUSION: A Web-based tutorial can help pediatricians impart accurate information in a supportive framework about DS. The training modules can be viewed at www.brighter-tomorrows.org.From a broader perspective, this study suggests that Web-based communication training strategies can be effective not only for resident physician communication with families about the unexpected diagnosis of DS, but also for pediatricians communicating with parents about unexpected diagnoses of other life-altering illnesses and disabilities.