Oncotalk: Helping Physicians Practice the Art of Medicine

Oncotalk: Helping Physicians Practice the Art of Medicine

Miriam Knoll, MD

@MKnoll_MD
Sep 03, 2015

I hesitated when I was offered an opportunity to participate in Oncotalk, a communication course geared towards oncologists. The two-day training is facilitated through conversations with actor-patients. I had many experiences with standardized patients (also called OSCE— Objective Structured Clinical Examination) in medical school, and I did not enjoy the artificial interactions. While the faculty certainly meant well by giving students an opportunity to demonstrate learned skills (i.e., give instructions to a mom about her son’s asthma medications), I felt that a passing score was earned if a) the actor was in a good mood, or b) I said a pre-scripted statement the actor was told to listen for. My prior interactions with standardized patients had been mostly to pass exams; the actor would note whether I demonstrated skills I learned previously.

In contrast, Oncotalk is a training session wherein one practices and develops skills that are often newly learned. The two-day course is divided into sessions. Each session starts with didactic teaching of a new communication skill, such as how to identify when a patient’s emotions are primarily driving their responses, and how to deal with that emotion before continuing to impart more information. The facilitators present a clinical scenario that the group will act out with a patient (actor). Each member of the group interacts with patient individually while practicing the new skill, and the remainder of the group and Oncotalk facilitators listen and then give immediate feedback. “Time outs” and “do-overs” of the interaction are encouraged when the conversation isn’t going well, so that one can identify and improve difficult aspects of the communication.

Oncotalk’s premise is that communication skills and expressions of empathy can be learned in the same way other medical procedures are learned: by watching others communicate effectively and by practicing in a supervised environment. This is similar to the medical education axiom “see one, do one, teach one.”

Practicing new skills in this way is important because learning a new way to converse (whether with a friend, family member, patient, or colleague) is extremely difficult. For example, when delivering bad news, it’s common to say, “I’m so sorry.” During Oncotalk, I practiced saying, “I wish things would have worked out differently.” Forcing these words out and receiving immediate feedback from the group reassuring me that it sounded okay to their ears was very comforting. When I went back to real life and real patients, it was easier to incorporate the techniques I learned because I had already used the skills multiple times during Oncotalk.

Oncotalk was featured in the Washington Post earlier this year, reflecting the importance of communication training to doctors and to patients. The Internet makes it possible for patients to publicize their opinions regarding their medical care in an unprecedented way. Often, public opinion of doctors’ empathy is extremely low (whether of individual doctors, or the profession as a whole).

As a group of physicians who chose to sacrifice and dedicate their lives to treating patients with cancer, oncologists don’t truly lack empathy. What physicians may lack are skills that impart the true empathy they have—skills that can be learned and practiced through programs like Oncotalk. Difficult conversations are so draining because of the deep feelings we already have for our patients, and most of us have never learned optimal ways to deal with these feelings. Oncotalk taught me how to recognize, accept, and reassure my patients, so the conclusion of the conversation leaves both of us with clarity and closure. This training enables me to better practice the art of medicine, not just the science.

Oncotalk’s success has prompted the expansion of VitalTalk, its parent nonprofit organization. GeriTalk is a course geared towards geriatrics and NephroTalk towards nephrology. Because of the variability of communication training in medical education, individual medical centers and medical specialties prioritize participation in these courses on a case-by-case basis. Oncotalk’s true success will be recognized when communication skills training becomes an integral and commonplace component of medical education.

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Comments

James Randolph Hillard, MD

Sep, 08 2015 2:19 PM

This sounds like a great program.  My only concern is that it is two days long, making it sort of unrealistic for most practicing oncologists to work into their schedules.  Do you think that a four hour "short course" could be useful, or would it just be a "sub therapeutic dose"?

Miriam Knoll, MD

Sep, 08 2015 4:16 PM

Thanks so much for your comments. I agree that setting aside two days for a course is a big commitment and creating half-day sessions could enable more people to participate. Perhaps a series of shorter courses offered on a weekly basis for four weeks? I was happy that my course was over two days (a Thursday/Friday) because it allowed me to focus fully on the training. Having the weekend afterwards was important, as well. Despite knowing the interactions were fake, most of us felt emotionally 'spent' during the course and needed time to decompress.


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