Residents in a Room

Episode Number: 61

Episode Title: Ask the Communications Experts

Recorded: January 2024

(SOUNDBITE OF MUSIC)

VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

We're thrown into residency with a lot of medical knowledge, but delivering that medical knowledge is definitely an art.

How do you resolve conflict with fellow residents, fellow members of the operating room team?

The best way to learn is by watching other anesthesiologists.

DR. MAUNA RAO:

Welcome to Residents in a Room, the podcast for residents by residents. I'm Mauna Rao, CA1 at Baylor College of Medicine, today's host, and I'm here with doctor Matt Hatch, Chair of Asa's Committee on Communications, and Dr. Asha Padmanabhan, a committee member. Both are part of a subgroup who developed ASA's Enhancing Patient Communications program, which launched in 2021. So we're very happy to hear what you guys have to say. Before we pepper you with questions, I'm going to ask my fellow residents to introduce themselves as well.

DR. SHREYA RANJAN:

Hey everyone, my name is Shreya. Um, I'm one of the CA1's at Tufts Medical Center.

DR. JAO HO KIM:

Hi. Uh, my name is Jao. I'm also a CA1 at Tufts Medical Center.

DR. ROA:

Drs. Hatch and Padmanabhan, can you also share a quick intro?

DR. ASHA PADMANABHAN:

I'm Asha Padmanabhan. I'm an anesthesiologist in, uh, private practice for several years in down in South Florida and part of the ASA committee as well.

DR. MATT HATCH:

And I'm, uh, Matt Hatch, OB anesthesia fellowship trained anesthesiologist, trained at Wake Forest. Uh, I stayed on faculty there for about 10 to 12 years, uh, and then switched over to private practice, where I've been working for the last, uh, 4 to 5 years. So I've got a kind of a good mix of academic and private practice experience. Um, and happy to be here.

DR. RAO:

Great. Thank you so much. We've all heard that better patient communication leads to better outcomes, but can you talk about why good communication is so important for improving patient care?

DR. PADMANABHAN:

Sure. I think it's just not patient care. Right. It's every single aspect of whatever we do. Communication is such a key part. But specifically for this, for patient care, let's start with thinking how it really improves patient care. So take the time when you are going to introduce yourself to a patient and you walk in and you introduce yourself, you've got about ten minutes or less, sometimes less, to get that patient who you've never seen, who has never seen you, to come to trust you. And so what will help you gain that trust the fastest? And that's how good or how badly you communicate.

So I've seen personally plenty of examples where communication hasn't been the greatest. And the minute you leave the room, the patient has told the other team members, oh, I never saw my anesthesiologist today. And that's where it starts. Start starting with introducing yourself, starting with being clear about your role in the team and how you're leading the care.

So how does it improve patient care, starting with building trust. Secondly, it also helps you to be able to, with that introduction, to be able to put that patient at ease, to explain to them what exactly you're going to do to get them to understand the entire process because they are coming in so, uh, terrified of some sometimes the most stressful moments of their life. And if you don't communicate well with them, then they are going to be left stressed out. So that's where I think it starts. So building trust is a key part. And then uh, also when we lead into the next parts, we'll see how building around the entire team, the communication skills are so important.

DR. HATCH:

Yeah. And I would just I would echo you know, you talk about better outcomes. You know, I think many of us unfortunately we minimize the importance of that patient interaction. I think we we've trained for so long and we have so much information that we're trying to cover. Uh, and I especially remember as a resident, I had to cover, you know, everything, make sure I talked about, you know, myself, the anesthetic plan that I was going to have. And we kind of minimize the importance that the patients put on this time. And we, you know, we're trying to spend so much time getting through our side, trying to be cognizant of the of the start times and getting back to the room on time. A lot of physicians kind of forget that the patients really value that time, and that has been shown in their satisfaction scores, which is a metric that that Medicare looks at. Just that time with the physician is valued very highly by the patient. And patients that felt that they had a better connection with their physician, be that anesthesia or their surgeon or any physician interaction, those patients have better satisfaction scores, which leads to to better outcomes. And so I think it's something, you know, we gloss over a lot of times, but it's so critical to start that trust process early in a very short and efficient amount of time.

DR. RAO:

I agree, I really like the firm verbal verse that gets, um, passed around. I think, you know, just the idea that taking the time and communicating is akin to giving a med that we would normally give is pretty profound.

DR. HATCH:

I mean, I've heard some of my colleagues, especially those who've been out in practice for a while, talk about some of these communication skills or how to improve communication. They say, well, I don't have the time. You know, just I can't spend 45 minutes with a patient. And I don't think better patient communications means that you have to spend that much time. But being deliberate about the time and how you communicate with that patient and their support system, be that a spouse, be that family, be that a friend or a partner. I think being deliberate and conscious of how we do that can be, you know, so important. And not just saying, well, I spent 45 minutes with them, why are they not happy with who I am or how I introduce myself?

DR. RANJAN:

Is it only about patient care, or does good communication with patients benefit anesthesiologists and anesthesiology as well? What are the benefits beyond patient care?

DR. PADMANABHAN:

Everything hinges on communication, right? So think about a time when you are in the operating room and you are running into a problem with a surgeon. And what skills are you bringing to the table in terms of how you react to that stressful situation? That is where the communication skills that you develop are going to be so important. So it's not just for patient care, but team building within the operating room with your surgeon, with the operating nurses, with the team, the pre-op, the PACU, all of those areas, how well you communicate with them is going to impact how well your OR runs, how well your anesthetic runs, how well that patient gets taken care of. Everything that you say and do is going to be affecting how that patient is taken care of. And then apart from that, think of the relationships you build in the hospital with the administration. And we all know that we no longer are a live in a silo or work in a silo. So what we do affects everything within the hospital. The ORs are the moneymakers of the hospital. And so we have a very important role to play. And that's where I think communication comes in as well, is the relationships you build with the people who run the hospital. That's just one aspect of it.

Another aspect I think, is also advocating for our patients with the legislators. We all know that we talk about how well the team care model works with the nurse anesthetists. And yet in the wider world, there is very little perception of what an issue it could be when the physicians are taken out of the care team model. And so being able to communicate the value of our of the work we do to our legislators, to the lay public, and again to the patients themselves so the patients become our advocates when they are talking to their legislators. That's where I think it's very key that we develop these skills, because not only our professions, but also our patients lives, and the care that they get is so dependent on it. And so really, it's not just how we communicate with a patient, but how we communicate with everyone around us. That's going to be so key to this.

DR. HATCH:

Oh, I, I couldn't agree more. One of the work products that that the ASA and this committee, the COC, has come out with is the toolkit and the enhancing patient communications. But, you know, I on a day to day basis, just think of the the interactions I have with the pharmacist and trying to figure out, is there a drug shortage and how do I communicate with that pharmacy team; with the OR nurse manager, and how do we coordinate, you know, staffing of operating rooms and whether or not we can open up more; with hospital administration on whether or not we'll have a site open up on a OR holiday or not; to my surgical colleagues, to politely explain to them why a case may have to be postponed while we work up a patient for new onset shortness of breath; to to working with anesthesia colleagues such as nurse anesthetists or AAs, and coming up with a anesthesia plan with a person who may have their own ideas of what we should be doing anesthesia wise. And so, you know, communication and having the good skills to communicate well, really, I think, affects us on every level of my job on a, you know, pretty much a minute-by-minute basis.

And there is also a selfish reason to have better communication skills. I think they have, you know, shown that when anesthesiologists feel that we are communicating better and we feel that there is that better team atmosphere at work, both with our patients and with our colleagues, there's much better job satisfaction. You know, burnout is such a headline topic right now and such a real problem. I have colleagues who, you know are sick of work. There's just so many things. But I think if you can develop good communication skills and, with your team, that will lead to better job satisfaction, which I think is is so critical right now at all levels of anesthesiologists, from a trainee to a newly graduated person to someone who's going to retire in a week. I think, you know, it's a very important and real problem.

DR. PADMANABHAN:

And I echo that about burnout, because it's so hugely important that we come away from from our jobs or our everyday work feeling, uh, satisfied and happy. So absolutely echo how important that is.

DR. KIM:

ASA launched a program and toolkit called the Enhancing Patient Communications Program, which currently includes a toolkit and CME course. Why is a program like this needed and why now?

DR. HATCH:

Well, you know, as the chair of this committee and have been on the committee for years, it's a product that I'm really proud of. And I'm really saying this not at all to toot my own horn, because I think as all the reasons that we have talked about before, I think that this toolkit has the opportunity to have a huge impact on so many levels in terms of patient satisfaction, better outcomes on so many different levels.

But really, I'd like to explain kind of its inception and kind of how it all came into existence. So basically, an anesthesiologist had some simple observations. Uh, Doctor Craig de Lanzac, who's the current ASA secretary, um, was a former member and chair of this committee. Just started thinking, how many communications does an anesthesiologist have with patients and that patient support team every single day? This is, you know, across the nation every week how every month. You know, if you look at every single operating room site, outpatient surgery center, plastic surgery office, whatever those numbers of interactions gets to be a pretty staggering amount of interactions. It's an impressive number of things. And each one of these interactions is a chance for us to communicate, you know, to advocate for our profession, what we do, to talk about what we do to that patient and family, to separate our our role and the role of every other team member on that team to that family that they will they will meet with. And we can utilize this time well. We can, you know, build that connection. We can, uh, advocate of why a physician should be involved in their care, what it is that we do as the physician anesthesiologist in that care. We can take advantage of the interaction or we can just let it slip away. And so, Dr. de Lanzac, in thinking about this, just spent a week just kind of self reflecting and kind of just listening to his colleagues around the, uh, holding room area. And he would hear some colleagues would have some good introductions and some families, uh, interactions. And while some of these were good and very kind of wow, that was a great comment. He heard, unfortunately, some distressing conversations, some doctor coming up saying, hey, I'm Dr. so and so. I'm just here to sign consent and get you off for anesthesia. Someone just mentioned, hey, I'm just one of the anesthesia folks just here to take care of you. That's, you know, I'm here to do. He would overhear family members, uh, talking to themselves after a colleague left. Kind of just saying, who was that person? I didn't really understand what they were doing doing here, that it wasn't a great interaction. Um, he would hear colleagues maybe minimizing a patient's concern or walking away, as a patient was saying, but I have a question about something. And he just felt that maybe this is something that we should do or work on.

And so, you know, we really think as physicians that we do an awesome job of communicating, uh, very similar to about the 80% of Americans who think they are above average drivers. Do the math. Can't really be true. So you add the fact that we all think that we're overconfident. We have patients. Over 60% of Americans don't even know that anesthesiologists are physicians. And as Dr. Padmanabhan mentioned, many of them don't remember even meeting us. There was this problem. I mean, clearly we think we do a good job. Patients don't think we do a good job. He had some personal observations in operating rooms. So realize that maybe we need to do something about this. Maybe the ASA or the Communications Committee could develop something to help physicians, residents, anyone going into the field of anesthesia on just giving tips on how we can better communicate with patients. So the committee kind of developed this toolkit, which can be found on the ASA website. It is not something to say, here's how to say in this situation, say X. And then if you meet this kind of a patient, say Y. But just getting us to self-reflect on maybe things that we could improve on in how we communicate with patients, you know, such as, you know, engaging the patients, coming prepared for for that, that interaction. And so I think that's where all of this stemmed from. And coming from his sense of, wow, there's a lot of bad interactions that could be happening out there. And just from his observations and the total number of of interactions that we can have, that maybe this is something that that we could work on.

I do think advocating for our patients and for our specialty, it, you know, is needed now more than ever. Every scope of practice bill that may come out saying that nurse anesthetists can practice without physician supervision is is pretty much saying that what you do doesn't matter. And so, you know, I think you all are, you know, have trained in medical school or in a residency to get a job as a physician anesthesiologist. And so you may interact with the legislator who says, But I'm trying to pass a bill saying that a nurse anesthetist does not need you around. And so how do we communicate not only with patients to make them advocates, but with our our legislators as well? And so I think it's so important for us to have those skills and communication to be able to speak well with our patients, but then also to their family members, to their legislators, to the hospital administrators and so on.

I would encourage every physician anesthesiologist to just take a look at it as a, as a tool in the same way that, you know, you may go ask someone, what's a good regional anesthesia textbook? Or where's something I could learn about how to do a better interscalene block? I think this is something. If you're looking for ways to to work on your communications. This is a free and simple toolkit and CME module that you can use to help improve those skills.

DR. PADMANABHAN:

Yes, and a lot of work went into it. You are residents. You've seen interactions that patients have had with some of your attendings. And you may recognize good ones and some bad ones. Have you seen some really bad interactions?

ALL:

Yes. Yeah, yeah.

DR. PADMANABHAN:

And did that person who had that bad interaction actually recognized that they were not communicating appropriately?

DR. RAO:

You know, sometimes it's even me on call at two in the morning trying to explain a procedure for an emergent case. And it's like I'm not doing a good job and I can tell they're scared. Or, you know, it's always this, like, I wish I had not a script, but something to go off of to make this more streamlined because everyone's lost.

DR. PADMANABHAN:

Yes. And you said that, right? Script. Right. I mean, scripting is how we learned how to take a history, how to do a physical, all those things we all learned through scripts and from listening to someone who was doing a good job. And then you kind of took good things from all the people that you worked with or, uh, learned from. And then you put it together to make your own script. So this product is giving you a script to go off of and then expand upon by yourself. So that's where this really helps, I think, is to look at it as kind of a, um, a guideline or a framework that you can use giving those of us who have had that, those bad patient interactions the chance to learn when something like this happens is where this is going to help.

DR. HATCH:

Yeah. And I would just like to clarify, it is a starting point. You know, if I can say anything about communication is there is no right or wrong answer to to some extent, you know, there are different ways of doing it. And this gives you a good starting point. But I think one of the best things I've learned over time is just, this is a lifelong process. And I think hearing some good feedback and hearing some good interactions, um, is a great start for me. But I don't I don't want people to think that, you know, if they hold this up and read it, it's an end all be all. But it's a good starting point, but not meant to, you know, something that you'll adapt and work with your entire life as you interact with different patients and see things. So it is a script in one sense of it does give you some starter. ideas and ways of phrasing things, but it's not meant as well. This is the only way to do it. And if you don't follow the ASA toolkit, you're doing it incorrectly. It's a script as a starter, but not as a the only way that that you can do this and be a successful communicator.

DR. KIM:

Uh, I'd just like to quickly echo what Dr. Padmanabhan has mentioned of, um, you know, everyone witnessing maybe not the very best conversations. Um, but I also do know it's not always intentional. Uh, we're all vulnerable. Sometimes we have good days, sometimes we have bad days. But I think tools like this, uh, will most certainly help us become more more aware of. Maybe not our our best communication skills. Um, I know we're kind of thrown into residency with a lot of medical knowledge, but delivering that medical knowledge is is definitely an art. And I hope this tool, uh, truly gains a lot of traction because I think especially now, tools like this will kind of help sharpen our, um, what's called EQ or emotional quotient. Um, as well as our situational awareness and all of the nuances that come with communication skills. And also, um, I think tools like this will help residents and attendings, all anesthesiologists, connect better with patients, which will ultimately improve what was mentioned before, job satisfaction, and also a more meaningful interaction with patients.

DR. HATCH:

Yeah, I think that's very well put.

DR. RAO:

So the program teaches anesthesiologists to introduce themselves clearly and establish their role as the physician and leader of the anesthesia care team. Can you talk about why this is important? What risks are associated with the public not understanding our specialty and our role in patient care and the perioperative process?

DR. PADMANABHAN:

Yes. So although this goes for every every physician, I want to come to this specifically from a female physician point of view. And this is because ad nauseum, I've heard from every single female physician colleague I have, including myself, that we are taken, uh, as nurses. And I cannot tell you the number of times I've introduced myself to a patient as a physician and ten minutes later, someone comes into the room and they are telling them, oh, my nurse is just talking to me. This happens over and over again. So when I first started my attending career, I was I wanted to be casual and be friendly with the patient, and I was just introducing myself by my first name. And I very soon realized how wrong that was, because then not only was I the nurse, but then putting myself on that level, the trust wasn't there as much. Uh, now it's different sometimes. I've seen my male colleagues do that. They've introduced themselves by their first name, but they seem to command a different kind of presence. So I think it's really important to introduce yourself as the anesthesiologist and their doctor. In fact, now I basically tell them I am your anesthesia doctor because a lot of them don't understand what anesthesiologist means. So make sure you introduce yourself as a physician who leads the care team and works with a nurse anesthetist if you have one, but that you are the leader of the team.

DR. RANJAN:

So what are some ways we can improve how we communicate with patients? Do you have some tactical tips you can share with us?

DR. PADMANABHAN:

Yes. So like I said in the previous question, I now introduce myself as Dr. Padmanabhan, your anesthesia doctor for the day taking care of you. But the second part of this, the tactical tip I would really love to share with you, is something that I learned not that long ago on how to put the patients at ease and how to make sure they remember you, because at the end of the day, when they get called the following day for how well you did or your team did, they rarely remember the anesthesiologist. So humor is one way. Now, for those of us who are not naturally humorous, here's another way I found helpful is, what I learned was called the sandwich method, which was starting with something light and funny or light, doing the interview and doing the anesthesia talk that is explaining the anesthesia in the middle and then ending with something light. So typically now what I do is I introduce myself and ask something light on, you know, what they love to do is something like that. Then I explain the anesthetic and then end with either, you know, something light, what are you looking forward to eating today? Or I also love to talk to them as they're going under about their, uh, some beautiful place that they could go to. So I tell them, I'm going to give you a homework, pick out the most beautiful place that you can dream about or you want to go to. And we're going to talk about that as you're going under. And that really brings a smile to their face and excitement. And they start talking about all the best trips that they've had. So I found that that way, breaking the ice in the beginning, then explaining the anesthesia and then ending with something light that, you know, makes them, makes them remember you, which is essentially what you want as well. Right? So that's something that I hope everyone takes away from this.

DR. HATCH:

So those are great points, Dr. Padbanabhan. And you know, if I had any tips first, get to know yourself. You know, we all come into to this world. You've all gotten to where you are through a different path, different parents, different experiences, different backgrounds. So take a look at yourself. How do you communicate? Are you a fast talker? Are you a person who loves to connect and tell funny stories? Are you more shy? Learning how you communicate is a great step and knowing kind of where you're going to have strengths and weaknesses. After you've kind of just looked at that for a little bit of time. I think putting yourself in somebody's shoes and then combining that with kind of looking at yourself and just realizing that everyone has had a different experience and thinking, well, you know, I got to this point because of this, but this person may have had a very different life story than I have, and what are the things that they're going to be wanting out of this experience, I think was so helpful for me to know my own weaknesses, but then realize that we all have our own biases, our own lens, that we view the world. And maybe that person has a different view of things. And I need to connect with that view at this moment in time.

And I would tell every one of you guys, this is not something you're going to take a class on or spend a week on and perfect it. I've been doing this for 15, 18 years. I'm still working on it. I mean, this is something that I try to practice deliberately all the time. People laugh, but I will ask nurses like, how do you think I came across to that patient? I will practice, I'll talk to my wife. I'll talk to friends who are not in medicine and say, I'm just going to ask you some questions and do you understand what I'm talking about? Or is that over your head? Is that too, you know, dumb down. It's awkward at first, but if you ask someone to to hear you give a spiel or to ask someone for for feedback, I think was so helpful for me, that's something I would kind of recommend is, you know, if you really want to improve on those skills is get feedback and then just practice it in front of people who are in medicine and those who are not, and just see how your you know, your script as you develop it, how that comes across.

DR. KIM:

How do we explain some of the complex procedures like intubation, for example, in language patients and families can understand? Do you have any advice on how we can pivot so we're using different language with patients than we are with our healthcare teams.

DR. HATCH:

So this is a really difficult challenge for all of us because, you know, we've spent, you know, four years of medical school, you know, learning how to to speak the scientific jargon. But that's not who our patient population is. These people have not gone to medical school for the most part. They have not had training. They've read about stuff on on the, you know, on the news or they've read or heard about stuff in social media and their friends.

What I try to do is I just think of someone in my life who I care about, who's not medical. Um, and how would I want to talk to them like I envisioned in my mind, my grandmother, nice woman, you know, finished high school, didn't go to college. Uh, was a stay at home mom her entire life. So her medical knowledge is not the best. And so I just think, well, how would she, you know, hear a term like intubation, you know, and so maybe. So we'll put a breathing device in after you go off to sleep. That may be something that she may hear, uh, hear and understand better. So that's what I would kind of say to everyone here is to pick a person, you know, either personally or in your mind, kind of made up. And how would they hear something? And that's why I think it's great to practice with non-medical colleagues. You know, I think if any one of us are around other professionals, like if you're around lawyers and hear them talking, let's be honest, a lot of that stuff that they say goes over our heads because we don't know their, their language. And so, you know, if we if you talk medical terms to a non-medical person as a practice, they may say, what do you mean you're gonna do a nerve block and then, you know, put a central venous line in like slow down, like, tell me, tell me in layman's terms what what that means. Think of these patients as not you're attending. This is not for a test. This is just how do I use different terminology with kind of the average Joe is the best way I can kind of say to pivot and kind of get back to that, uh, patient.

DR. RAO:

I like that a lot. I try to imagine that my patient is a family member that isn't trained in medicine and how I would want a procedure to be explained to them and try to come from that perspective when I'm talking to them. I think that's really helpful. All right. And for our final question, um, what are some of the ways we can be more sensitive and aware of tailoring our communications for specific patient populations like seniors, children, obstetrics from culture or ethnic differences to language barriers and varying religious or spiritual beliefs and beyond. How can we become more culturally competent in the care that we provide? And if we don't have easy access to resources to help us here, such as translators and other resources, do you have tips on how to advocate for these kinds of resources?

DR. PADMANABHAN:

Sure I can deal with a couple of these specifically because I live in South Florida and we have such a huge patient population that doesn't speak English. And when I see that patient in my operating room, I always think about how terrifying it must be to be in a place where they don't understand the language and they are now putting their life in someone's hands who they don't even understand what that person is saying. So I think each of us needs to be very culturally sensitive to to the language. And yes, many of us might be lucky enough to have translation services available, like the hospital systems have translation systems available. I found even when at night, when sometimes we don't have these, your simple phone with your Google translate, you know, speaking into it and have it speak the language to them that can help as well. Although now I'm I'm not going to talk to the medical legal aspects of that, but just to get the patients comfortable, that might be the way to start. And then following your hospital policy on whatever it is that you need to get the medical translation for. So language, that's one thing.

The second thing is, coming from an immigrant background, I do understand how it can be very disturbing for specific patient populations to have their care given by someone who is not of the same gender. And so to be to be sensitive to that and just not dismiss it as something that if you are in this country, this is the care that you get and just be thankful for it. Because I've had colleagues who have voiced those kind of opinions and, you know, think of what it would be if if you were in that situation in a foreign country, and wouldn't you want your, not just rights, but your beliefs to be respected? So I think it's really important that we do that as we treat our patients, as we would like to be treated like, Dr. Hatch said, putting yourself in their place is probably the best thing to do and how you would like to be treated, and that's why we could be, we definitely have to tailor our communication for these populations.

DR. HATCH:

It's such a an important part of communication is realizing that everyone may want to get information and need to get information in a different way. You know, I'll never forget my kind of aha moment of realizing the importance of this was, you know, my college roommate asked me one time if I had ever felt awkward pulling up to a gas station and filling up my car with gas because I was the only person of a certain skin color. And I said, I grew up in Indiana. I never had a problem with that. And then it just hit me. I was like, wow, maybe other people may have had an experience of feeling awkward pulling up into a gas station, being the only person of a certain skin type. And again, I think that started my whole realize my process of just thinking. Maybe my experience is not everybody's. And so I think trying to connect with your patients in a very in a way, even if you don't connect with them on it because you've experienced something like, I don't know if any of you have children, but I think doing pediatrics with not having any children and then doing pediatrics afterwards and seeing parents anxiety. Before I had kids trying to emulate, well, what would it be like if I had a child and I was nervous, and this child is coming in for, you know, ear tubes or, you know, now that I have two kids, what is it like for an obstetric patient and her partner to come in and ask questions about an epidural, or is that safe for the baby? Or what happens if there's a C-section? Again, it to me, I think it boils down to just looking, how would that patient want to be heard or what do they need to hear that may be different than how I'm presenting it to them. I think is is so important to really connect with our patients and on all levels and from a variety of backgrounds and anesthesia care settings.

So one of the things that I really have been noticing over the years, especially being in academics for about ten, 15 years, I'd love to talk to you guys and ask your thoughts. So you all have had classes on how to dose a regional nerve block like an interscalene catheter, you know, what additives to add and should you do? Uh, maybe a long acting local versus a catheter, but how many of you have had formal education in patient communications during your residency or even medical school training?

DR. RAO:

I think in medical school, it was definitely a lot more, um, emphasized. Um, we had specific communications classes. We were taught how to motivationally interview patients, how to get comfortable with patients and try to establish trust. Um, but I'm happy to say in residency, I think we've had a series of classes focusing around this, um, on how to get informed consent about general anesthesia, how to deliver bad news, um, how to quickly establish trust with your patients, how to deal with combative patients. So, um, we've had a few formal lectures which have been really helpful because they end up turning into workshops where we kind of practice on each other and someone pretends to be the difficult patient and someone is, you know, trying to calm them down. And it's kind of fun.

DR. RANJAN:

Yeah, I would echo that. Um, I think we had during our foundations period, um, at the beginning of CA1 year, we had a few lectures on informed consent. I think one of the lectures that we all really found helpful was a conflict resolution lecture. And it was, it ended up being interactive with how to resolve conflict with fellow residents, fellow members of the operating room team, circulating nurses, PACU nurses and patients. And I felt like that was very, very helpful. Um, but I do think that a lot of the communication skills that I have learned or have yet to learn is just kind of observing what my, like, senior residents and other co residents and attendings do and kind of also seeing what not to do. One of the things that Dr. Padmanabhan had mentioned earlier is that she was introducing herself, um, by her first name earlier, and I definitely did that because that's what I saw a lot of my co residents doing. Um, and a lot of them were male. And then, you know, after having had a few interactions where, you know, they didn't think I was a doctor, I started introducing myself as Dr. Ranjan. And so I think it's very much like a day to day each attending or senior resident just gives like little tidbits of, you know, useful tips that I've started incorporating into how I communicate.

DR. PADMANABHAN:

I have to say, I'm impressed because I didn't have any of this in my residency. The residency programs are definitely doing a good job moving forward if you're you guys are already having these kind of discussions and lectures, because for sure, if we had had anything, like you said, on good communication, how to get informed consent, conflict resolution, that would have helped a huge lot. So I'm impressed.

So going forward, what do you think would help you become better communicators? And is there anything specific that any skills that ASA can address that can really help you?

DR. RAO:

I mean, I agree with Shreya. I think the biggest thing, the best way to learn is by watching other anesthesiologists adapting their phrases, um, you know, placing a breathing device to when you go off to sleep, things like that to, um, kind of translate for yourself, um, what you're trying to communicate in terms of ASA skills that they can address, um, it would really be, I think, growing in our identity as an anesthesiologist and what that means as a physician anesthesiologist, um, so we can communicate that role better if we understand ourselves better.

DR. KIM:

I'd like to echo what Dr. Rao said in terms of watching other anesthesiologists. I think outside of the the formal education, a lot of the supplemental education has also come from watching my attendings and my my seniors. And I think at least at Tufts Medical Center in Boston, it's it's helped that a lot of our attendings are from, you know, all across the world, learning from from their communication skills and their unique backgrounds and their upbringings. Um, I think that has helped really add to, you know, my own personal toolbox, um, just growing as a resident and hopefully becoming a competent anesthesiologist, attending. And then in terms of just becoming better, I think just constant repetition and practice and also just putting yourself in in a variety of patient populations. I know at where I train, there's a variety of patients who speak Cantonese, Mandarin, Haitian Creole, um, and just getting those repetitions and, you know, meeting people from all across the world and from different backgrounds, constant practice has helped me become a better communicator.

DR. HATCH:

Would something in the sense of, you know, you are currently all residents sitting in your own cases, and a lot of you will probably go out into a private practice setting where you're now supervising or directing an aesthetic up to four sites with nurse anesthetist. Would any kind of product kind of dealing with that communication of going from sitting a personal anesthetic myself to now having to communicate with colleagues who are also doing the anaesthetic and saying that they're a doctor of nurse anesthesia. Would anything on those lines be a helpful tool for new residents coming out, or new attendings, in terms of dealing with that communication, slash transition into private practice or kind of academic life?

DR. RAO:

Absolutely. I think that kind of falls along the lines of conflict resolution or just trying to understand what, when other people are communicating something that you find is maybe not accurate, how to collaborate with them to, I guess, clarify what they what they mean. Um, and I think to do that in a way that is, um, supportive and not confrontational or, um, I guess antagonizes them, but, you know, acknowledges them as one of your team. But again, saying, like, you know, there is a leader of that team and, you know, a good way to understand those roles better. I think that would be really helpful.

DR. RANJAN:

Yeah. Definitely agree. I think, um, especially being a new attending, I've just seen a few of our like, CA3s last year who are now attendings at Tufts Medical Center. And just the transition of the role from being a resident to now an attending. You know, when you're a resident, you're doing your own room, a CRNA is doing their own room. And now the people that you were kind of, you know, working together with, now you're kind of supervising them and just how to kind of transition from being a resident to an attending and the change in the role and the responsibility. And again, like how to like, explain to patients how you are different from a CRNA, um, would be really helpful. And that's something that I think I haven't quite learned how to like express that yet. Um, especially to patients.

DR. HATCH:

Just encourage all you guys, everyone here like I'd love to be a resource. I love the ASA to be a resource, the Committee on Communications to be a resource for anybody out there if they have questions or help and not if I can't do it, I will try to direct you to somebody who can, because I think it's it's such a valuable tool for all of us to to improve all of us, myself included. You know, I think all of us can improve on how we communicate on a day-to-day basis.

DR. PADMANABHAN:

Yes. And to every resident who listens to this as well. We are there as resources for you. The committee is there as a resource for you. You can reach out to Dr. Hatch or me and ask for things like this that Dr. Ranjan talked about and the tools that Doctor Hatch was talking about, how to bridge that gap between resident to attending in how you communicate. So yeah, we can come up with all these things. So reach out to us.

DR. RAO:

We well, thank you so much everyone for the great conversation. It was very interesting and educational. We hope our listeners got something out of it too. If so, please follow and leave a nice review and join us again for more Residents in a Room, the podcast for residents by residents.

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