Virginia Tech Carilion School of Medicine Assesses Students Communication Skills Before Admitting

By Edward Leigh, MA

Have great grades?  Excel in science?  Thinking of medical school?  Think again!  Medical schools are now realizing that excellent academics are not enough to become a great doctor.  Communication skills and the ability to work in teams are vital.

Virginia Tech Carilion, located in Roanoke, Virginia, is one of the newest US medical schools (the school opened in August 2010).  Their medical school admission interviews go beyond the typical questions, “Why do you want to be a doctor?” The medical school has added a communication component to their admission interview process.  Great grades alone will not prepare prospective students for this part of the interview process; great “people skills” are needed.

Communication skills are more than “bedside manner.”  These skills also directly impact patient safety. According to the Joint Commission, “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.”

This is how the medical school interview process incorporates communication skills:
• Candidates stand with their backs to doors.
• A bell rings and they turn around and read a sheet of paper taped to a door. The paper will have a scenario that requires communication and teamwork skills. (The school requests that the actual scenarios be kept secret.)
• After two minutes, the bell rings again and the candidate enters the room to discuss the ethical issue with an interviewer.
• The candidate has eight minutes to discuss that room’s issue. The interviewer scores each candidate with a number and sometimes a brief note.
• The process is then repeated several times.

The school administrators created questions that determine how well candidates think on their feet and their ability to work in teams. The interviews closely assess how well they respond when someone disagrees with them.  This is a critical skill in working with teams.

According to the school, “Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.”

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion.

Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, developed the system. He states, “Candidate scores on multiple mini interviews have proved highly predictive of scores on medical licensing exams three to five years later that test doctors’ decision-making, patient interactions and cultural competency.”

The emphasis on communication and teamwork does not end with the medical school interviews.  Medical students at Virginia Tech Carilion are required to take team-based classes.  The school also requires students to become involved in community projects.

The mini interviews help shift the discussion away from personal narratives (that are usually rehearsed) to focus on the student’s problem solving abilities.

For more information about Virginia Tech Carilion’s innovative medical school application process, please contact Dr. Stephen Workman at SMWorkman@carilionclinic.org

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s newest book is Engaging Your Patients (due out in early 2012).
http://www.CommunicatingWithPatients.com or 1-800-677-3256

How to Plan a Successful Patient Satisfaction Fair

Wheeling Hospital held their first annual patient satisfaction fair to educate employees on current process improvement projects related to enhancing patient care. The fair was developed to encourage interdepartmental communication as it relates to patient-centered care. The medical center felt it was very important that each department knew the activities of other departments to enhance teamwork.

Heidi Porter, the Director of Quality Management, shared tips on how your medical center can plan its own patient satisfaction fair.

Educate employees on patient satisfaction.  Plan educational events to help employees improve the patient experience.  Wheeling Hospital had several educational opportunities for employees. The hospital emphasized the focus on patient satisfaction is not just for “bottom line” reasons. Yes, based on changes in healthcare, reimbursement does tie into patient satisfaction scores (e.g., HCAHPS). However, it is important to emphasize to employees this focus on patient satisfaction is related to delivering outstanding care and improving patient safety.

Form a Patient Satisfaction Committee. Wheeling Hospital formed a patient satisfaction committee that meets monthly to focus on improving the patient experience.  One of their projects is the fair.

Be sure every department has a display / booth. Each one of Wheeling Hospital’s thirty departments were asked to create a display and discuss their patient satisfaction initiatives. For example, the radiology department discussed using contrast material that tasted better to patients since this was often an issue. The lab discussed scripts to use to be sure patients understand their lab reports.

Involve everyone in each department.  The people staffing the booths were not always directors.  Many front line staff were present, especially since they are the people who have the most direct patient contact.

Have materials at the booth. Nearly every booth had written information on their various projects. This is important so fair attendees have information to review.

Plan ahead.  Wheeling Hospital planned the event well in advance to create a successful event.  Time is needed to make sure all the necessary arrangements are in place.

A patient satisfaction fair is an excellent opportunity for each department to share their projects.  Make plans to have a fair at your medical center.  Heidi Porter has graciously agreed to answer questions about starting your own fair.  Heidi can be reached HPorter@wheelinghospital.org

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

My Mother’s Recent Emergency Department Experience: Lessons for Learning

My mother, Julia, is part of a clinical trial, which involves monthly infusions.  The clinical trial protocol requires periodic blood work, scans, x-rays, etc.  Last week, the physician leading the clinical trial called me at my office and said that my mother has atrial fibrillation and they will not proceed with the monthly infusion. They also noticed that one of my mother’s legs was red and swollen; they were concerned about a possible blood clot. They suggested calling an ambulance and having my mother taken to the closest Emergency Department (ED). I agreed to this action. They then called the ED to inform them of the atrial fibrillation and possible clot.

I called the ED to mention that my mother is on her way and also told them that before leaving my office I will fax over my mother’s medical history information. I have a two-page summary of my mother’s pertinent medical information (e.g., medications, hospitalizations, allergies, etc.).  I told the ED that my brother and I would be there shortly.

Overall, everyone at the hospital was very friendly. However, there were several parts of the experience that could have been improved. This article is a summary of the issues with suggested changes.

Problems with hand off. When my brother and I arrived at the ED, we went to my mother’s room and the nurse told us that their tests did not find atrial fibrillation and that my mother was going to be discharged now.  I asked about the issue with mom’s leg.  They said, “What issue?” In spite of the fact that the clinical trial physician clearly stated the leg needs to be evaluated for a possible DVT, that information never made it to the ED records.  After discussing the leg issue, my mother was scheduled for an ultrasound.  (As an FYI, the ultrasound revealed no clots.) To avoid these botched communication episodes that could seriously harm patients, professionals should engage in “repeat back.” After the information is shared the receiver must “repeat back” the information to verify accuracy.

No partnership statements.  The relationship between the patient and professional is not about giving orders; it is about forming a partnership. Upon admission to the ED, all patients should be asked, “What would make this an excellent experience for you?” What does great care mean to you?” We need to immediately understand the patients’ needs. If we are to be truly patient centered, we need to understand the needs of the patient.  In order to work as a team, we need to understand the patients’ needs.  Working as partners leads to quality improvement and better clinical outcomes.  Of course, this partnership approach leads to higher patient satisfaction.

Use of medical jargon. The people at the ED did not know I was a healthcare professional. They often used medical jargon that I understood, but what if I was not in the field?  When they scheduled the ultrasound, we were told Mom was being evaluated for a DVT. The abbreviation, DVT, was never explained. This is a serious problem in healthcare — the constant use of medical jargon that patients often do not understand.  This is known as a problem with “health literacy.” (The term literacy could mean problems with reading, however it often refers to the ability to understand the language of medicine.)

No signposting. This is a communication strategy in which people are given an overview of what will take place during their stay.  Streets have posts with signs on them (street names) hence the term “signposting.”  These posts with signs give people direction; that is exactly what we want to do with patients, give them direction.  In other words, tell then what will be coming up in regard to their care. This could as simple as saying, “First we will assign you to a room, run some tests and have you seen by one of our highly-qualified doctors. Based on the results of the tests, we will let you know how long you will be here.”  Patients should also be told that we are here to help you and make your stay as pleasant as possible.  There was one significant fact not revealed to our family that could lead to serious damage with patient satisfaction scores.  After being in the ED for approximately 1 1/2 hours, I asked our nurse, “When do you think my mother will have the ultrasound?” She then smiled as though she was about to laugh!  She said the average time for an ultrasound is 4 1/2 hours, but it could be up to 8 hours! This fact should have immediately been told to us.  (As an FYI, we had the ultrasound done in about 3 hours.)

Lack of hourly rounding.  After my mother was in the ED an hour, I expected someone from the medical center to check in on Mom.  No one came to see how Mom was doing.  Hourly rounding is a critical tool for many reasons.  This process helps prevent potential falls by asking patients if they need anything, such as a trip to the bathroom.  Many patients are seriously injured each year because they have to use the restroom and no one is coming to check on them. They try to get up on their own and sometimes fall.  The rounding also has a psychological benefit in that you are reassuring patients that you are thinking of them and working on their care.

No empathy. Going to an ED is a very stressful experience. During my mother’s time in the ED not one person directly stated an empathic response.  I would have liked to hear at least one person say, “I know it is scary being here. However we are here to help you.”  This comment should often be followed by a partnership statement, such as, “We will work together with you to find out what is going on as soon as we could. We will periodically check on you, but if you ever need anything, please feel free to let us know. We are here for you.”

Directions — don’t just tell, show!  When I arrived at the ED, I asked the person at the front desk what room my Mom was in and they told me. I asked for directions. The directions were very complicated due to ongoing construction. The person at the desk said something to this effect, “Go down this hall, turn right at the first hallway, then make an immediately left, go down the corridor until you get to a desk, then make a slight right, etc. What? Huh?  I then asked, “Could you have someone take me there?”  They agreed. When people ask directions, don’t simply give directions; take them to their requested destination.  This is an excellent customer service tip all hospital staff should incorporate into their work with patients and their family members.

Teach back technique not utilized.  After the ultrasound was completed, we were given discharge instructions.  Being in healthcare, I understood all the directions, however what if I was not in the field? Saying to a patient, “Do you understand?” is not sufficient.  In order to determine if they indeed understand, you must use the communication technique called, “teach back.” Ask the patient to summarize the information you provided. This could be as simple as asking, “Tell me what you will do when you get home.”

In summary, all of the hospital staff members were quite pleasant.  However, there were some very significant problems that could have negatively impacted my mother’s health. Based on a poor hand off, the ED was unaware of the leg issue.  Fortunately, my mother did not have a DVT. But what if she did?  This medical center needs to have staff development training covering communications skills, rounding techniques, educational strategies and customer service. These techniques are more than “bedside manner” tips; rather they are skills to avoid potentially serious medical errors.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Edward Leigh’s new book, Engaging Your Patients, is due out in June 2011!

Stop Devaluing Your Patients! The Illusion of “Patient Centered” Care

In healthcare, we always talk about, “patient-centered care.”  I do believe healthcare organizations have the best intentions, however, in reality, I find just the opposite both in my work as a healthcare speaker / consultant and with my own experiences as a patient.

“Just a Patient”

I have been a healthcare professional for over 20 years, however in 1999 I became a patient after being diagnosed with Stage III Colon cancer (I am well today). After treatment was completed, I recall going to my oncologist’s office for a follow up visit. I was wearing a suit as I was on my way to a client meeting. In the office, I was talking to a pharmaceutical representative. During my conversation, a nurse ran up to the representative and said to him, “You don’t need to talk to him. He is just a patient.”  Immediately another nurse (who knew me), ran up to the nurse who made the comment and said, “I can’t believe you said that him! He teaches healthcare professionals how to communicate with patients and now he will use us as a bad example!”  The second nurse then said to me, “You aren’t going to mention this story, are you?”  I told her, “Of course I will not mention the story.”  Ha!

Are the people you serve, “Just patients?”

Discouraging Patients from Taking an Active Role in Their Care

In healthcare, we discuss patients being their own advocates and taking an active role in their care.  Once again, what is said and reality are often not the same.  In my work at coaching healthcare professionals, I have seen patients bring print outs from their Internet research, only to be told, “Don’t worry about the Internet, I know what is best.”

When patients come to you with Internet print outs, the first words out of your mouth should be, “THANK YOU!”  We need to encourage people to take an active role in their health, not discourage them.  The conversation should then follow up with a discussion of legitimate websites (e.g., NIH) versus quack websites.

Patients Matter

When I speak at healthcare events, I always position myself as a healthcare professional who also happened to be a patient.  For one event, I made the mistake of first discussing my patient experiences and then I saw just how poorly patients are seen in the healthcare system.  The meeting coordinator said to me, “How nice you want to share your story. However, this is a program for professionals only. No patients are invited.”  Even though I explained I was a healthcare professional, once they saw me as a patient, I immediately had no value. I felt like I was verbally patted on the head and told to “run along.”

Let’s stop talking about putting patients first and just do it!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Match Your Patients Energy Level

 

When people come into the healthcare system, it is a safe bet that they are not doing cartwheels in your hallways. They don’t feel well and their energy levels are probably low.  However, if we are high energy (which is great!), that would actually overwhelm people. Patients may be turned off by healthcare professionals that are busting at the seams with enthusiasm. A friend of mine told me her daughter who was hospitalized with pregnancy complications. Her daughter was in significant pain.  The daughter mentioned one nurse who used to bounce in the room full of energy; the daughter found this boundless energy too much for her.

It would seem to make sense that energy and enthusiasm are excellent characteristics of a healthcare professional.  They are!  However, when establishing rapport with patients we have to think about matching energy levels.  If our energy level is very high and  the patent’s energy is very low, we could experience a communication disconnect. This is exactly what happened with my friend’s daughter. The nurse though being high energy would be a good way to establish rapport.

We need to meet patients where they are. We need to meet then at their level of energy. Does this mean that if a patient is depressed and low energy we need to become depressed? Of course not!  However, what we need to do is lower our energy a bit so we do not cause a communication disconnect.

Mirroring and matching are techniques used to establish rapport at the unconscious level. This is created by becoming like the person with whom you need to make a connection. We need to make a connection with patients! When talking to patients look at their gestures and vocal inflexions. In a subtle way try to “match” these behaviors.  Subtle is the key word; we do not want to make it obvious or the patient may think we are mocking  them. People feel more comfortable with people who act like them.  For example, if your patient uses a lot of certain hand gestures, you may need to increase your level of these hand gestures.

If you look at people in the workplace or social situations who seem to be very engaged, notice they most likely have similar body language and tone of voice.  They are in sync.  We need to be in sync with our patients through the the strategies of matching and mirroring.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Study Reveals HUGE Communication Gap Between Patients and Physicians

The Archives of Internal Medicine recently published a study that surprised many physicians who thought they were communicating effectively with patients. A group of Yale researchers study results are very concerning.

Several findings revealed a very significant communication disconnect between patients and physicians.  The gap is alarming.  Here are two examples:

Physician Name — Study found that:

Patient Survey: More than 80% of patients did not know the physician taking care of them.
vs.
Physician Survey: The majority of doctors thought the patients knew their name.

Admission Diagnosis — Study found that:

Patient Survey: About  50% of patients did not know their admission diagnosis.
vs.
Physician Survey: The vast majority of doctors thought the patients had understood their diagnosis.

These results indicate significant works need to be done to narrow the gap between what healthcare professionals say and what patients understand.  This comes through education.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

The Cleveland Clinic Improves the Patient Experience … by Improving the Hospital Gown!

The hospital gown. They have become a standard joke among comics who talk about being in hospitals.  If patients do not fasten them just right, their derrieres (or other body parts) may be on display for all to see!

The Cleveland Clinic wants to change the hospital gown and they have enlisted the help of a glamorous fashion designer! Fashion icon Diane von Furstenberg created a unisex patient-friendly, comfortable, wraparound apparel that looks good on everyone.

Jeanne Ryan, committee chair, stated, “The original goal had been to improve patients’ hospital experiences. We wanted to provide people with some dignity. They come to the hospital, it’s very stressful and then we ask them to take off their clothes. People said they feel exposed.” The gowns are expected to become available to all patients in the Cleveland Clinic’s Ohio facilities sometime in 2011.

Everything a hospital does creates either a negative or positive “patient experience.”  This initiative certainly enhances the patient experience.  From my work at enhancing the patient experience, I know that these little changes have a big impact. Bravo to the Cleveland Clinic!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

MD Anderson Cancer Center Offers Innovative Patient-Professional Communications Program

The Interpersonal Communication And Relationship Enhancement (I*CARE) programs are excellent educational tools developed to enhance the communication skills of oncology professionals. The program is part of MD Anderson’s Department of Faculty Development. The program developers strongly believe that “skillful communication is a competency that can be taught and learned.”

The I*CARE program mission: “Most cancer clinicians have not had the opportunity to develop their skills in managing difficult patient encounters such as those where there are strong emotions, stressed families or uncomfortable conversations when transitioning a patient to palliative care or discussing end of life. Oncology providers want to extend their role beyond treating disease to establishing a therapeutic and supportive alliance with the patient and family. Our goal is to assist you in sharpening the skills necessary to manage these challenging encounters.”

I*CARE PROGRAM INITIATIVES

I*CARE Website

The website, http://www.mdanderson.org/icare, contains the MD Anderson Cancer Center’s Video Library of Clinical Communication Skills and is an educational resource for communication skills development. The video library helps with understanding the basic principles of communication and advanced skills such as discussing end-of-life issues and error disclosure by providing specific protocols that can be used and illustrating them with video re-enactments.  Free Continuing Medical Education (CME Ethics credit is available) and Risk Management credits are available to physicians enrolled in The University of Texas Professional Liability Insurance Plan. People may download materials for teaching purposes.

Programs

There are many program options, including fellow & faculty forums, interactive workshops, train-the trainer sessions, conferences and the quarterly Achieving Communication Excellence (ACE) lecture series.  One program, “On Being An Oncologist,” features actors William Hurt and Megan Cole who assume the personas of various doctors. Using dialogue gathered by physician focus groups, they share their feelings about the stress of caring for patients with life-threatening illness; the time pressures; the challenge of breaking bad news; the need to keep hope alive; the balancing of sympathy and empathy and keeping personal boundaries, as well as dealing with both the patient’s and their own emotional reactions.  A workbook with reflective exercises can be downloaded for both teaching and learning purposes.  In the Spring of 2011, there will be a new program launched for patients and families to learn how to communicate their needs to their medical team, and specific information on the cultural aspects of communicating with patients. 
One-on-one Coaching

Trainers observe healthcare professionals with patients and feedback is provided.

Research Opportunities

There are many ongoing research projects such as assessing aspects of the patient / oncologist relationship through audio taping clinical encounters and the impact of empathic statements on a patient’s emotional state.
These outstanding initiatives are making a big impact in helping oncology professionals successfully connect with patients on an interpersonal level.

Walter F. Baile, M.D., is the I*CARE Program Director and Cathy Kirkwood,
M.P.H., is the I*CARE Project Director. For more information about I*CARE, visit: http://www.mdanderson.org/icare

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Houston’s St. Joseph Medical Center offers Innovative Method to Communicate with Non-English Speaking Patients

St. Joseph Medical Center (http://www.sjmctx.com) recently became Houston’s’ first hospital to use a unique translation system.

A special phone is set up with two handsets, one for the patient and one for the professional.  Based on the language requested, a trained medical interpreter is immediately brought on the line to help the patient and professional communicate.

The phone system is produced by CyraCom (http://www.cyracom.com) and offers interpreters specializing in 150 languages.  The trained interpreters are familiar with medical terminology, which is critical when speaking about healthcare topics.

If the language is not immediately obvious, patients review a card attached to the phone that has questions in their language. They can use this card to select their language.

Every patient room at St. Joseph has one of the phones. The sets are also located in the medical records department, triage and the front desk. There are a total of 400 phones throughout the hospital.

In healthcare, clear and concise communication is critical. This innovative tool helps avoid language-related issues to provide the best care to patients.

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Medical Students Learn what it is like to be a Resident in a Long-term Care Facility … by becoming a Resident! The Learning by Living© Project

Empathy in healthcare is all about understanding what it is like to be “in the shoes of “ a patient / resident.  Medical students at the University of New England College of Osteopathic Medicine learn what it is like to be a resident in a long-term care facility by becoming a resident!

The Learning by Living© Project is the brainchild of Dr. Marilyn R. Gugliucci, Director of Geriatric Education and Research at the College of Osteopathic Medicine.  In this innovative program, medical students are “admitted” into a long-term care facilities to “live the life” of a resident for two weeks.  Each student comes with a diagnosis and appropriate treatments. For example, if the student is admitted in a wheelchair, the student must stay in the wheelchair for every activity, including changing clothes and bathing.

Prior to the development of this project, students learned about long-term care via traditional methods (e.g., lectures and brief visits).  

In 2005, the first medical student was “admitted” into a Maine long-term care facility to live the life of a resident. Each summer since then, Dr Gugliucci has admitted students into long-term care facilities.  The students do not return home at the end of the day; the students live in the facility on a 24/7 basis.

Dr. Gugliucci maintains constant contact with students portraying an adult daughter of the student acting as a resident.  The students carefully document their experiences. The long-term care facilities provide a bed and meals at no cost.

The program has a 100% success rate!  Follow-up data reveal that students practice medicine differently because of their experience of living in a long-term care facility.  According to Dr. Gugliucci, students gain the following by having this experience:

• Importance of physical touch, voice inflection, and word cadence when working with patients.
• Enhancement of communication by being at eye level with the patient, whether they are in a bed, a wheelchair, or on a treatment table.
• Communication with authenticity and sincerity, emphasizing the importance of being comfortable sharing with patients.
• Connection with and treating the person rather than the diseases or frailties of the patient.

Currently, the University of New England College of Osteopathic Medicine is the only medical school in the country admitting students into long-term care facilities for extended periods to live the life of a resident. The plan is make this a nationwide project. The project is also applicable to nurses and other health profession students.

The Learning by Living© Project is being filmed for a documentary, due out in June 2011.

For more information about the Learning by Living© Project, please contact Dr. Marilyn R. Gugliucci at mgugliucci@une.edu

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256