A Simulation-Based Communication Skills Training in Treating First-Episode Psychosis for Psychiatry Residents
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LETTER TO THE EDITOR
A Simulation-Based Communication Skills Training in Treating First-Episode Psychosis for Psychiatry Residents Vasilka Natacha Deleva 1 & Daniel Zigman 2 Received: 7 February 2020 / Accepted: 12 July 2020 # Academic Psychiatry 2020
To the Editor: Psychiatric residents have limited opportunities to divulge a diagnosis of first-episode psychosis (FEP) and follow FEP patients. Patients and family members identify a need for psychiatrists who are able to share diagnoses [1]. Patients with schizophrenia who participated in focus groups stated that learning their diagnosis legitimized their distress and helped them understand their illness and its treatment, but some express dissatisfaction with how the diagnosis was communicated [1]. Family members describe being left out of health care discussions, yet being required to care for the patients once discharged from the hospital [2]. To address these concerns, we designed a simulation program to practice communication skills relevant to treating youth with FEP including “breaking bad news” and engaging patients and their families in shared decision-making. The SPIKES model [3] was used and consists of Setting the stage, eliciting patient Perceptions, Inviting the patient to discuss the subject, sharing Knowledge, attending to Emotions, and developing a Strategy to move forward. Twelve third-year residents participated in the training. Residents were encouraged to read articles about communicating a diagnosis of schizophrenia [1–4]. The event started with a 30-min didactic teaching session covering as follows: (1) SPIKES framework and challenges in applying it to FEP, (2) conclusions of the readings, (3) potential responses to common patient and family concerns. The simulation then began. Actors portrayed the same patient and his mother at different times in the first months of care. Residents were divided in groups of 3; each performed one scenario while the two other observed. Residents were encouraged to have the SPIKES framework in mind when approaching the
* Daniel Zigman [email protected] 1
Université de Montréal, Montreal, Quebec, Canada
2
McGill University, Montreal, Quebec, Canada
scenarios. A faculty member led a 15-min debriefing after each scenario. The actors attended the final debriefing and gave feedback about their experience. Residents were encouraged to reflect on the manner in which they conveyed information and emotions experienced. In the first scenario, a 16-year-old teenager is brought to the emergency room. His mother found him with a knife attempting suicide in response to hallucinations. He had psychotic symptoms for 5 months, was drinking alcohol and using cannabis, and had a family history of bipolar disorder. The psychiatrist meets with the patient and mother and is asked to clarify the diagnosis and to establish a treatment plan. The second scenario takes place 3 weeks later when the teenager is discharged from the inpatient unit to a day hospital. The psychotic symptoms are improving with medication. The patien
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