Research and education programs at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai are designed to ensure that the entire team of health care professionals has the knowledge and skills necessary to provide the highest quality patient-centered care to patients and their families.

Toward that end, a team of Mount Sinai faculty developed GeriTalk, an intensive two-day, evidence-based training course for fellows and staff that focuses on teaching and practicing effective communication skills.

The curriculum includes didactic presentations and demonstrations; small-group practice; and coaching for clinicians in a position to present bad news, negotiate goals of care, and discuss the pros and cons of life-sustaining treatment, including do-not-resuscitate orders.

Since the 2009 inception of GeriTalk, an important element of Mount Sinai’s didactic curriculum, more than 100 fellows and numerous faculty and staff throughout the Mount Sinai Health System have received this training.

Published research shows an improvement in clinicians’ skills and an increase in their confidence levels when having to communicate difficult choices to patients and their families. Participants’ post-session evaluations have been overwhelmingly positive.

“We know this course is critically important,” says Elizabeth C. Lindenberger, MD, Director of the Palliative Medicine Fellowship and Associate Professor of Geriatrics and Palliative Medicine, and Medical Education. “Communication is the most important procedure we do. Having the skills to communicate effectively is not intuitive and, like any skill, needs to be learned.”

When the COVID-19 pandemic hit, the education team was challenged to find a way to present the course virtually.

Lindsay A. Dow, MD, Assistant Professor of Geriatrics and Palliative Medicine, who has been teaching GeriTalk since 2015, collaborated with other educators nationwide to develop a program that included not only lectures, but also interactive components, because role-playing is an essential element of the program.

“We knew early on in the pandemic that we had to adapt this program to a virtual format so we would be prepared for a possible COVID surge,” says Dr. Dow.

She and her colleagues developed four, two-hour Zoom sessions that consist of listening to 20 to 30 minutes of lecture, watching faculty members interact with actors as they apply the skills being taught, and practicing what they learn. Prior to the start of each online course, participants complete an interactive online module that allows learners to work at their own pace and maximize Zoom time for practicing.

During the sessions, all participants, including the actors who role-play the part of patients, are logged in on their own computers remotely in gallery mode. During practice sessions, all learners turn off their video so only the clinician acting out and the “patient” are in view. This allows the group to focus on the interaction and to take notes for specific feedback. Participants continue to receive active coaching after the completion of the course.

“We were keenly aware of what might be lost without the in-person human connection,” says Dr. Lindenberger. “But we were pleasantly surprised at the hidden silver linings we found.”

She cited an unexpected feeling of intimacy experienced when a participant is interacting with just one person within the confines of a screen. For example, without colleagues in the room and the pressure of feeling watched, participants feel less self-conscious. A Zoom format also affords the opportunity for more faculty from across all Mount Sinai campuses to participate without having to set aside time for travel.

In addition, GeriTalk via Zoom offers the benefit of scalability. If fellows and other staff can learn just as well virtually, then the program can be taught by more faculty and offered to more physicians, nurse practitioners, and social workers across the Mount Sinai Health System.

“We’re trying to remain as flexible as possible, to use as many modalities as we can to provide this important communication training,” says Dr. Lindenberger. “It becomes another tool in our toolbox.”

Since beginning the remote sessions, faculty have run six courses attended by 39 participants, two for geriatrics and palliative care clinicians, and four for oncology clinicians.

“Words cannot express the gratitude I feel for helping me start on this wonderfully rewarding journey of healing through communicating,” said Rashmi Kaura, MD, a graduate of the Integrated Geriatrics and Palliative Medicine Fellowship at The Mount Sinai Hospital, referring to GeriTalk. “I came to Mount Sinai with a passion to ease suffering, and the insight that I didn't know how to do this with grace and artistry. I was like a music conductor with a symphony in my head, but without a baton or the knowledge for how to wield it,” she said. “Then I went to GeriTalk, and it all fell into place. Not only did I find my baton, I practiced how to use it and, to my own ears, I could hear the symphony begin to play out.”