COD 10: Leading discussions with patients, families and/or other health care professionals in emotionally charged situations

Key Features

• This EPA focuses on the application of advanced communication and conflict resolution skills to address difficult situations that may involve patients, families, and/or members of the health care team.
• This EPA may be observed in any scenario that is emotionally charged. Examples include managing conflict (parent/physician; patient/physician; patient/parent; physician/health care professional), disclosing unexpected complications and/or medical errors, addressing non-adherence with treatment plan (e.g., vaccine refusal), and breaking bad news.
• This EPA does not include end-of-life discussions (TTP).
• This EPA includes documentation of the encounter.
• This EPA may be observed in a simulation setting.

Assessment Plan

Direct observation by supervisor with review of documentation

Use form 1. Form collects information on:

• Type of communication: addressing non-adherence with treatment plan; breaking bad news; disclosing unexpected complication and medical errors; managing conflict
• Setting: inpatient; outpatient; ICU; simulation
• Adolescent: yes; no
• Interpreter: yes; no

Collect 5 observations of achievement.

• At least 3 different types of communication
• At least 1 from each of setting
• At least 1 observation of a communication with an adolescent
• At least 4 different supervisor observers

CanMEDS milestones

1. COM 1.2 Ensure the physical environment is suitable for the nature of the situation (e.g., privacy, safety)
2. COM 1.5 Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately
3. COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
4. COM 1.5 Establish boundaries as needed in emotional situations
5. COM 3.1 Share information and explanations that are clear and accurate
6. COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family
7. COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
8. COM 4.3 Answer questions from the patient and/or family
9. COL 2.2. Listen to understand and acknowledge other perspectives
10. P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment
11. COM 5.1 Document the clinical encounter to reflect discussion and decisions