Communication training for orthopedic surgery residents seeks to enhance interactions with older adults

A program to improve orthopedic surgery residents' communication skills with older adults is having a positive impact, according to a new study. The program at Hospital for Special Surgery (HSS) seeks to enhance third-year residents' interactions with older adults by sensitizing the residents to their needs and dispelling negative misconceptions.

A study discussing the results of the Hospital for Special Surgery program was presented at the Council of Orthopaedic Residency Directors meeting on June 24, 2016 in Seattle.

Good communication skills are an important attribute for all physicians, yet patient surveys nationwide have shown that these skills are often lacking. It can be an even greater challenge for doctors when the patient is an older adult.

"By 2030, 20 percent of the U.S. population will be over 65, as predicted by the Centers for Disease Control and Prevention. It is vital for physicians to develop effective and sensitive communication skills during their residency training to promote positive outcomes with older adults who often perceive themselves as stigmatized and powerless in healthcare settings," explained Linda Roberts, LCSW, assistant manager, Greenberg Academy for Successful Aging at HSS and program leader.

"This ongoing program has been valuable on many levels, but fundamentally helps our residents become more caring physicians, and not just surgeons," said Mathias Bostrom, MD, an orthopedic surgeon and residency program director at HSS.

Good communication is vital to the delivery of high quality health care, according to Charles Cornell, MD, clinical director of Orthopedic Surgery at HSS, who started the program.

"Orthopedic surgeons are increasingly tasked with treating elderly patients with a variety of injuries and degenerative conditions," he said. "Inadequate communication between doctor and patient is well documented to be a source of patient harm, risk of complications and poor patient satisfaction with their care. We are grateful to the Hartford Foundation for a two-year grant that helped us launch the training program. We believe it begins the process of enhancing communications skills for the residents and hopefully sparks their interest and awareness of this largely ignored issue in 21st Century medicine and surgery."

The communication training at HSS consists of two parts. A social worker who specializes in aging issues meets with small groups of two or three residents to make them more aware of the needs of older adults and teach effective communication skills.

Sessions explore negative stereotypes about older adults and potential resident biases arising from personal and professional experiences. Myths and facts about aging are reviewed. The importance of creating a partnership with older adult patients versus the "doctor knows best" culture is discussed. Residents are coached on how to deliver a presentation to an older lay audience.

After the sessions, the residents present a musculoskeletal topic to a group of 20 to 30 adults age 65 and older, and then demonstrate exercises corresponding to the specific orthopedic condition in smaller groups. The workshops provide intense interaction with older adults with differing needs. A physical therapist is also present for the demonstrations.

Sixty-four orthopedic surgery residents participated in the program from 2009 to 2015. Researchers started collecting evaluations in the program's fourth year, with 25 residents completing the questionnaires. They were evaluated before and after the training using surveys that assessed medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging.

"Significant changes were seen in residents' attitudes and anxiety levels toward older adults, attributes which, for anyone, regardless of background and professional status, can be deep- seated and hard to change," Roberts noted.

Survey results showed the program's positive impact:

• Knowledge: Mean knowledge scores of residents significantly increased from 57.3 to 72.0 out of 100 on aging and older people.
• Anxiety toward older adults: Statistically significant change was found in the residents' anxiety level with regard to the enjoyment of talking to older adults.
• Attitudes toward older adults: Residents showed improvement in their attitude toward older or aging adults.

The program reached 674 older adults from 2009 to 2015. The majority were female (89 percent), between 65 and 84 years old (71 percent). They completed a survey after the sessions, and the program received positive ratings. Ninety-six percent of the older adults "Strongly agreed/Agreed" that the residents had demonstrated sensitivity toward them.

"The program provided me with an opportunity to interact with older patients before an injury occurred. I was impressed by how informed and proactive they were," said Peter Derman, MD, an orthopedic surgery resident who participated in the training. "I would recommend a similar program for any medical specialty. As the population ages, we will all be taking care of more and more older patients. It is imperative that we can tailor our care and communication techniques for this demographic."