B55-30 Development of Communication Strategies in Hierarchical and Non-Hierarchical Clinical Contexts Through Improvisational Acting and Simulation-Based Training

Problem Statement

Communication failures in critical care contribute to preventable medical errors, impaired team performance, and unsafe care environments. Despite recognition of its importance, communication training for fellows remains inconsistent across hierarchical (ICU) and non-hierarchical (research/QI) environments. This variability limits fellows’ ability to adapt communication strategies, affecting clinical decision making and collaboration. Existing curricula often lack experiential rehearsal and cross-context transfer, leaving trainees underprepared to communicate across settings.

Targeted Needs Assessment

A pre-course focused assessment of critical care fellows at a single center revealed heterogeneity in formal communication training and confidence in applying communication strategies across team structures. Peer feedback identified gaps in negotiation, nonverbal cue recognition, and role clarity.

Primary Goal

Equip critical care fellows to communicate with intentional presence and professionalism across hierarchical and non-hierarchical clinical settings.

Objectives

Implement a one-day curriculum aligned with ACGME Critical Care Medicine milestones and CCF HRO (High Reliability Organization) principles.

- Demonstrate effective active listening and closed-loop communication

- Identify and respond to verbal and nonverbal cues

- Exhibit leadership behaviors promoting psychological safety

- Adapt communication strategies across team structures

Educational Strategies and Curriculum Design

Curriculum planning involved interdisciplinary meetings between critical care faculty, simulation education specialists, curriculum leads, and improvisation specialist. Design aligned with adult learning and simulation best practices.

The curriculum integrated three educational approaches

1) Improvisational communication training emphasizing inclusive language and nonverbal cue awareness

2) Narrative reflection and professional identity formation

3) High fidelity simulation using communication-intensive ICU and non-ICU scenarios.

Simulation scenarios included

a) Dual patient respiratory failure and cardiac arrest requiring role assignment and closed-loop communication

b) Plane crash survival lab requiring group consensus without assigned leadership

Implementation and Learner Evaluation

Eleven of twelve critical care medicine fellows participated. Pre and post-course surveys assessing communication confidence across settings were completed by all participants. Faculty observation rubrics assessed communication behaviors.

Key Outcomes/Results (see graphs)

Substantial increases in communication confidence were observed across hierarchical ICU and non-hierarchical environments. Fellows agreed that communication competency should be a required component of training.

High impact elements included

a) Improvisational communication techniques integrated with simulation

b) Nonverbal communication awareness

c) Adoption of inclusive language

d) Psychological safety

e) Improved professionalism and interdisciplinary communication consistency

Conclusion and Next Steps

This improvisation-enhanced simulation curriculum improved fellows’ confidence communicating across hierarchical and non-hierarchical settings. Next steps include incorporating cognitive load management training; the curriculum is adaptable to external audiences and supports organizational HRO principles.

This abstract is funded by: N/A