Log in with your email address username.

×

Is breaking bad news to patients an art you can learn?

 

Being the bearer of bad news is often the unhappy duty of doctors, and can be incredibly challenging. Getting it right is not only hugely important for patients and their families, it’s also critical to the well-being of the doctors themselves.

Some doctors are better at it than others, but the good news is that even for those who don’t feel they manage it well, this is certainly a skill that can be honed.

“One of the lessons of the workshop is that communication skills can be learned and developed,” says Dr Ruvishani Samarasekera, a paediatric registrar at Sydney Children’s Hospital. “There are doctors who are not naturally empathetic or lack an emotional IQ, but they were still able to improve their communications skills to manage these situations better.”

Dr Samarasekera attended the Complex Communication in Health Care workshop under the guidance of Professor Stewart Dunn, a medical psychologist specialised in the psychological care of cancer patients and their families. The workshop uses actors playing patients in realistic scenarios where workshop attendees have to break bad news, often in difficult, complicated scenarios.

“There is not a lot of formal training  in breaking bad news in medical school,” Dr Samarasekera says. “Then, when you are a junior doctor the task is usually done by the most senior doctor. As you progress throughout your career, there is an expectation that you will then learn from what you have witnessed. But that’s not always the case.”

She recalls a very difficult case with a 21 year old patient in ICU who had complications related to morbid obesity early in her career.

“I witnessed the consultant telling the patient’s parents that he had passed away as a result of these complications. I remember how the consultant tactfully brought them into a private room and the non-verbal cues in the consult. I remember thinking how I wanted to communicate with such empathy and learn to use my own style as well.”

She says that learning and trialling diverse techniques in a workshop with actors is a very different experience to interacting and debriefing with colleagues. It is an immersive and safe experience that covers everything from the way doctors should be positioned in the consult to the words they should use, directly approaching the bad news or leading the patient towards it.

“Some scenarios we did were around breaking bad news with oncology patients, others were interactions with family members and telling them the news. And then there were other scenarios around daily communication skills with your colleagues.”

The course gave her more confidence that she could perform these difficult tasks, she says.

“I had a 10-year-old patient who’d been in and out of the ED over the course of two months with vomiting and clinically she had some concerning signs of unsteady gait. This was a red flag and so there was a looming question of whether this could be a brain tumour. Due to my earlier experiences observing my seniors in oncology combined with the practical skills gained in the workshop, I felt better equipped dealing with this emotionally challenging situation. From guiding the parents, preparing them for the likelihood of what the imaging would show and then discussing the results after.”

She says the situation was complicated by the fact that the parents had been in some denial about the symptoms and their child’s unsteadiness and had also at times received reassurance about them.

“You have to deal with this level of complexity; you have to be empathetic but honest, so that they are on your side as they go through the journey of diagnosis and treatment.”

Breaking bad news is one of the most difficult communications challenges in medicine, but not the only one. Dealing with colleagues, particularly at opposite ends of the hierarchy, can be challenging.

“One of the workshop scenarios that really struck a chord with me was one about being a junior doctor and dealing with the consultants,” she says.

The particular scenario involved a registrar being asked to be on call, despite a long-planned commitment towards a birthday party for her own child.

“The consultant very subtly manipulated her and made her feel like she couldn’t say no without losing something in her career. That kind of pressure is a huge part of medicine. The actors played out this scenario and the attendees had to decide whether they would intervene in the scenario they had witnessed. Talk to the consultant, perhaps, or try to empower the junior doctor. Some even thought the situation was not concerning, or that the junior doctor just needed to be more resilient. It was interesting to see how people responded.”

Professor Dunn will be moderating two workshops in Sydney on complex communication in health care this year. The workshops will cover breaking bad news, open disclosure, end-of-life conversations and dealing with conflict in the workplace. Read more about the workshops and sign up here.

Advanced Life Support Training: it doesn’t have to be face-to-face

 

It’s not always easy to get face-to-face training if you’re a rural or remote medical professional, or if you’re struggling to find a place on a course without a huge waiting list. If this sounds like you, then you may want to consider the CRANAplus Advanced Life Support Course, which is specifically designed for doctors who face logistical problems accessing face-to-face courses. doctorportal Learning now offers CRANAplus Advanced Life Support online certification. Based on the Australian Resuscitation Council (ARC) guidelines and best practice principles, this ACRRM-accredited module can be completed at your own pace from your preferred location.

It’s the only module in Australia that can be complimented with a virtual practical assessment to achieve an accredited ALS certification. Once you have the required equipment at hand, the practical assessment is completed via Skype (or equivalent) with a CRANAplus Assessor.

The module provides medical professionals with the advanced life support skills required in the management of the patient prior, during and after a cardio respiratory arrest.  A perfect solution for doctors who can’t easily access ALS, but who require the certification for their employment.

Course Features:

  • Self-paced online module
  • Virtual practical assessment with a qualified assessor
  • 30 ACRRM PDP
  • ARC approved

Click here for course information including module learning outcomes and practical resources required to complete the assessment. Discounted rate applicable for AMA members.

What do you want from your CPD?

 

Have you completed your Training needs and Analysis Survey yet? Complete the survey by 10th of January and provide us with your training requirements.

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible.  An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

What the Medical Board’s revalidation reforms mean for doctors

 

Last week, the Medical Board of Australia announced a major shake-up in the way doctors’ professional performance will be assessed and monitored.

In response to a report on revalidation from its Expert Advisory Group, the Board released its Professional Performance Framework, which it says will “ensure all registered medical practitioners practise competently and ethically throughout their working lives”.

The Board says its Framework has been five years in the making and will be implemented progressively, with some elements ready to go, while others still need significant planning, consultation and development. “Nothing is going to change tomorrow for doctors in Australia,” cautions Board Chair Dr Joanne Flynn.

With that caveat in place, here are the key changes the Board says it will progressively implement:

Added scrutiny of older doctors

Medical practitioners over the age of 70 will undergo mandatory competency and health checks, which will include cognitive screening. The Board says there is strong evidence on age-related risk of poor performance and that addressing this issue to keep patients safe is a “must”.

Doctors over 70 will also need to have their performance peer-reviewed every three years. This review will involve observation of the doctor at work, a review of the doctor’s medical record and feedback and discussion with the doctor. The results of this review will not be transmitted to the Board unless the doctor is deemed to be a risk to his or her patients.

The Board says even problems are identified, it won’t necessarily mean that the doctor would have to stop practising. There could be other solutions, such as reducing work hours, not being on call, or not performing complicated procedures.

At the same time, the Board has explicitly rejected the idea of a mandatory retirement age for doctors.

In Australia there are around 6,600 registered doctors over 70, including 800 doctors over 80.

Peer review of doctors with a high number of complaints

The Board’s Expert Advisory Group report found that around 3% of doctors account for nearly half of all complaints made to regulatory authorities.

In its Framework document, the Board proposes a pilot scheme in which doctors with several substantiated complaints against them are obliged to undergo a formal peer review, the results of which would be reported to the Board for further action.

The Board says it is looking at whether the threshold number of complaints that would trigger such a process should vary by specialty, noting that some disciplines, such as cosmetic surgery, tend to attract many more complaints than others.

Isolated practitioners

The Board says that doctors who practise on their own rather than with colleagues, or who practice outside clinical governance structures, may be at higher risk of poor performance.

It says it will strengthen its CPD system for these doctors, and increase its peer-review component. This could involve practice visits from college-designated doctors.

New CPD requirements for all registered practitioners

All doctors will need a “CPD home” and will be required to complete at least 50 hours of accredited CPD, some of which must include peer-reviewed work. Doctors will also need a professional development plan, similar to the one already required by the RACGP’s CPD program.

The Board says a broad scope of CPD is important. A quarter of CPD hours should be devoted to developing skills and knowledge, a quarter to reviewing performance and a further quarter on measuring outcomes. The final quarter should involve a combination of the above.

Improved performance monitoring of medical graduates

The Expert Advisory Group in its report noted that risk of complaints is related to poor performance in medical school or specialty training.

It has proposed early intervention for medical students or junior doctors suspected of a lack of professionalism or of integrity issues, such as dishonesty.

“A proven and irremediable lack of professionalism may preclude entry to the profession of individuals who are unfit to practise,” its report says.

 

You can access both the expert advisory group’s validation report and the Professional Performance Framework proposals here.

What do you want from your CPD?

 

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible.  An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

What you need to know about your CPD requirements

 

It’s hardly a secret that doctors are incredibly busy professionals. On top of all the clinical work, there are ever-increasing bureaucratic demands on practitioners, coupled with diminishing windows of opportunity to keep up with the latest advances in medical knowledge. It’s all too easy to put continuing professional development (CPD) on the backburner, leaving it for one of those mythical days when you have “more time”.

Do so at your own peril, however. There is the clinical imperative: many medical fields are moving so fast that if you don’t know about the latest developments, you won’t be able to offer your patients best practice. For example, one of the most common heart conditions, atrial fibrillation, is now being treated with a class of drugs – the so-called novel oral anticoagulants – that were pretty much unheard of not so long ago. Similarly, in just a few short years, the choice of drugs to treat type 2 diabetes has expanded considerably.

And then there’s the regulatory imperative. Many doctors are still unaware that AHPRA conducts random audits of doctors’ CPD activities. And if you haven’t fulfilled your requirements, there can be consequences. The Medical Board of Australia can impose conditions on your registration, or even outright refuse to register you. And although failure to undertake the required CPD is not a legal offence, it could be used in disciplinary proceedings against you as evidence of inappropriate practice or conduct.

Particularly vulnerable to being caught out are doctors who are not affiliated with a college – IMGs, doctors in training and non-vocationally registered doctors – don’t get the same prompts that other doctors get from their college to do their required CPD.

Doctors who do belong to a college need to meet the CPD standards set by their own college. For example, the CPD program of the Royal Australian College of General Practitioners has a mandatory Planning, Learning and Need (PLAN) activity which involves doctors looking at their practice, their patients and their patients’ demographics to work out the future CPD activities they should do over the next three years to support their skills and practice. GPs must then accumulate 130 CPD points, which must include one Category 1 activity and one CPR activity.

Doctors in training or who are non-vocationally-recognised must also demonstrate that they have fulfilled full CPD requirements. This involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.

Trainees need a signed letter or report from their supervising hospital to confirm their participation in training and education programs.

If you are randomly selected for audit, you will be sent an audit notice, and have 28 days to demonstrate that you’ve met the Medical Board of Australia’s registration requirements. These include not only your CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If you are found to be in breach in any of these areas, you can be reported to the Board.

See here for more information on CPD requirements for doctors who are not affiliated with a college.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your Medical Board of Australia CPD reporting obligations.

CPD audits: what you need to know

 

Although it’s been three years since AHPRA started randomly checking medical professionals’ declarations about their CPD activities, many doctors are still unaware that they can be audited.

Particularly vulnerable to being caught out are IMGs, doctors in training and non-vocationally registered doctors, who are not affiliated with a college and so don’t get the same prompts that other doctors get from their college to do their required CPD.

Here’s some key information about the auditing process:

  • Doctors under audit are sent an audit notice, and have 28 days to demonstrate that they’ve met the Medical Board of Australia’s registration requirements.
  • This includes not only CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If found to be in breach in any of these areas, doctors can be reported to the Board.
  • Doctors who belong to a college need to meet the CPD standards set by their college. But those who are not on the specialist register – whether they are in training or are simply non-VR doctors – must also demonstrate that they have fulfilled CPD requirements.
  • For non-VR doctors, this involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.
  • Trainees will need a signed letter or report from their supervising hospital to confirm your participation in training and education programs in the year being audited.

See here for more information on CPD requirements for junior medical officers, IMGs and non-VR doctors.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your MBA CPD reporting obligations.