Using Implementation Science to Adapt a Training Program to Assist Surgeons with High-Stakes Communication

Lauren J. Taylor, Sarah Adkins, Andrew W. Hoel, Joshua Hauser, Pasithorn Suwanabol, Gordon Wood, Wendy Anderson, Carolina Branson, Steven Skube, Sara K. Johnson, Amy Zelenski, Jennifer L. Tucholka, Toby C. Campbell, Margaret L. Schwarze

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: Surgeons often conduct difficult conversations with patients near the end of life, yet surgical education provides little formalized communication training. We developed a communication tool, Best Case/Worst Case, and trained surgeons using a one-on-one resource intensive format that was effective but difficult to scale for widespread dissemination. We aimed to generate an implementation package to teach surgeons using fewer resources without sacrificing fidelity. Design, setting, and participants: We used the Replicating Effectiveness Programs framework to guide our implementation strategy and tested our intervention with 39 surgical residents at 4 institutions from September 2016 to June 2017. The implementation package consisted of: (1) instructional video, (2) checklist to assess competence, (3) learner manual, and (4) instructor manual. We focused on 3 implementation outcomes: feasibility, fidelity, and acceptability to participants. Results: Attendance rates ranged from 16% to 75%. Site leaders had little difficulty identifying suitable instructors; however, resident recruitment proved challenging. Sixty-nine percent of residents completed the post-training assessment and the mean score was 12.8 (range 8-15) using the 15-point checklist. Across sites, 69% strongly agreed that Best Case/Worst Case is better than how they usually approach high-stakes conversations and 100% felt prepared to use the tool after training. Instructors reported that the training provided residents with the necessary skills to perform the fundamental elements of Best Case/Worst Case. Conclusions: Using implementation science we demonstrated that a resource intensive communication training intervention can be successfully modified for group-learning and wide-scale dissemination. However, we identified barriers to implementation, including challenges with feasibility and programmatic buy-in that inform not only resident education but also communication skills training more broadly.

Original languageEnglish (US)
Pages (from-to)165-173
Number of pages9
JournalJournal of surgical education
Issue number1
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
Funding: Dr. Taylor is supported by a training award (T32CA090217) from the National Institutes of Health and a Postgraduate Award from the Alpha Omega Alpha Honor Medical Society. Dr. Schwarze was previously supported by the Grants for Early Medical/Surgical Specialists? Transition to Aging Research Award (GEMSSTAR R03AG047920) National Institutes on Aging for this work and is currently supported by the Cambia Health Foundation Sojourns Scholar Program. Dr. Campbell is also supported by the Cambia Health Foundation Sojourns Scholar Program. These funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors have no conflicts of interest?including relevant financial interests, activities, relationships, and affiliations?to report.

Publisher Copyright:
© 2018 Association of Program Directors in Surgery


  • Communication
  • Education
  • End-of-life
  • Interpersonal and Communication Skills
  • Patient Care
  • Surgery
  • Systems-Based Practice


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