From the number of residents in the five programs, it is assumed that the surveys were distributed to 271 residents. A total of 182 residents responded to the survey; therefore, the response rate was 67.16% (182/271). The highest proportion of respondents was from Peking Union Medical College Hospital (n=49; 83.05%), followed by Xuanwu Hospital Capital Medical University (n=65; 81.25%), West China Hospital Sichuan University (n=34; 56.67%), Wuhan Union Hospital Huazhong University of Science and Technology (n=21; 47.73%), and Huashan Hospital Fudan University (n=13; 46.43%).
Residents’ demographic characteristics
The demographic features of the 182 resident respondents are listed in Table 1. Of the participants, 84.6% were female, which is likely representative of the current gender ratio in neurology training programs in China. The average age was 26.8 years. Residents from all postgraduate year (PGY) levels, from PGY1 to PGY5, completed the survey.
Table 1. Residents’ demographic characteristics
|
Age Range
|
Resident
|
%
|
20–29
|
155
|
85.16
|
30–39
|
26
|
14.29
|
40–49
|
1
|
0.55
|
Gender
|
Resident
|
%
|
Female
|
154
|
84.62
|
Male
|
28
|
15.38
|
Postgraduate level
|
Resident
|
%
|
PGY1
|
65
|
35.71
|
PGY2
|
55
|
30.22
|
PGY3
|
45
|
24.73
|
PGY4
|
6
|
3.3
|
PGY5
|
11
|
6.04
|
Hospital and University
|
Resident
|
%
|
Peking Union Medical College Hospital
|
49
|
26.92
|
Xuanwu Hospital Capital Medical University
|
65
|
35.71
|
West China Hospital Sichuan University
|
34
|
18.68
|
Wuhan Union Hospital Huazhong University of Science and Technology
|
21
|
11.54
|
Huashan Hospital Fudan University
|
13
|
7.14
|
Residents’ knowledge, experience, and confidence regarding difficult conversations in neurology
Residents reported a variety of clinical scenarios regarding difficult conversations they had experienced (Figure 1). The most common scenario (n=152, 83.52%) was dealing with emotional or unsatisfied patients and their families.
Figure 1. Frequency of various clinical scenarios regarding difficult conversations reported by residents
The majority of respondent residents (n=168; 92.31%) reported being exposed to at least one difficult conversation in their medical careers. One hundred forty-two residents (78.02%) had independently led a difficult conversation, of whom 82.39%(n=117)reported having failed experiences in difficult conversations. Only 30.22% residents (n=55) indicated being confident in independently dealing with a difficult conversation (Figure 2). The most common clinical scenario of a difficult conversation that the residents reported having confidence managing was obtaining informed consent (n=116, 58.24%) (Figure 3). The most common clinical scenarios of difficult conversations that the residents reported feeling heavy pressure to manage were dealing with emotional or unsatisfied patients and their families (n=134, 73.63%) and disclosing medical errors (n=120, 65.93%) (Figure 4).
Previous formal training in communication skills during neurology residency and the correlation with confidence in managing difficult conversations
The majority of respondent residents (n=162, 89.01%) demonstrated that efficient management of difficult conversations is a vital part of clinical procedures. However, only 99 (54.4%) believed that communication skills in difficult conversation can be improved through formal training (Figure 5).
Among 182 respondent residents, only 43 (23.63%) reported having previously received formal communication skills training. In comparison with residents without previous training, those with previous training indicated significantly more confidence and were under lower pressure in managing difficult conversations (P<0.05).
|
Residents receiving previous training(n=43)
|
Residents not receiving previous training(n=139)
|
P
|
Female (%)
|
35(81.4%)
|
119(85.6%)
|
0.504
|
Postgraduate level
|
|
|
0.024
|
PGY1
|
11(25.6%)
|
54(38.8%)
|
|
PGY2
|
11(25.6%)
|
44(31.7%)
|
|
PGY3
|
15(34.9%)
|
30(21.6%)
|
|
PGY4
|
1(2.3%)
|
5(3.6%)
|
|
PGY5
|
5(11.6%)
|
6(4.3%)
|
|
Confidence in managing difficult conversations (1 means not confident)
|
3.47
|
2.96
|
0.003
|
Pressure in dealing with difficult conversation (1 means no pressure)
|
2.60
|
2.99
|
0.037
|
Interest in receiving formal training in difficult conversations and barriers to implementation
Most of the respondent residents (n=165, 90.66%) believed that receiving formal training in difficult conversations was important for their careers. However, only 97 (53.3%) indicated interest in receiving formal training. Time, lack of enthusiasm, and lack of educational materials were the most commonly cited barriers to formalized training. Another important barrier was faculty expertise. Only 112 (65.74%) residents reported having experiences of being invited to participate in or observe difficult conversations between the faculty and patients or families. However, other residents (n=70, 38.46%) expressed regret that they had been excluded from difficult conversations by the faculty. After managing difficult conversations, few residents (n=26, 14.29%) believed they could get feedback from the faculty most of the time (Figure 6).