{"pk":52360,"title":"Patient-Centered Communication Case: Threatened Miscarriage","subtitle":null,"abstract":"<p>Audience: This communication case is intended for EM residents of all levels.</p>\n<p>Introduction:  Patient-centered communication is a necessary skill in the practice of emergency medicine. This style of communication is crucial for promoting high-quality healthcare by prioritizing patient needs, perspectives, and values. This patient-centered communication case centers on miscarriage, a diagnosis where patient-centered communication is requisite.  Approximately one in six or 17.1% of patients with a final diagnosis of miscarriage, also known as early pregnancy loss, present initially to the emergency department. Advising a patient of the diagnosis of miscarriage requires excellent communication skills including facile rapport building, empathy, nonverbal communication, and explanation of management options. </p>\n<p>Educational Objectives: By the end of this certifying exam practice case, learners will be able to:  1) establish a supportive and compassionate environment through verbal and non-verbal communication when engaging with a patient experiencing distress, anxiety, or grief related to potential pregnancy loss, 2) actively explore the patient’s understanding, concerns, values, and goals related to their pregnancy and presenting symptoms, 3) recognize and normalize a range of emotional reactions, offering validation and support regardless of the patient’s obstetric history or desired pregnancy outcomes, 4) clearly explain the diagnosis of a “threatened miscarriage,” outlining its clinical implications, inherent uncertainty, and potential outcomes, 5) review the results of any imaging or lab studies succinctly and empathetically, while verifying the patient's understanding, 6) collaborate with the patient to develop a mutually agreeable care plan, including medical recommendations, appropriate follow-up, monitoring, and return precautions.</p>\n<p>Educational Methods: This standardized patient case provides an opportunity to practice patient-centered communication and debrief on areas for improvement for the learner.  The case was co-developed by experts in simulation-based education and emergency medicine resident leadership. </p>\n<p>Research Methods: Facilitators evaluated the standardized patient case via a survey for efficacy, while learners evaluated it via a survey from the learner perspective. This case was tested in a serial fashion with incremental improvements based on feedback at each step: initially, both learners and facilitators at the case writer’s institution, then learners and facilitators at the annual SAEM meeting, and finally with both at an institution outside of the case writer’s institution. Three unique learners and three unique facilitators tested the case throughout the entire process.</p>\n<p>Results: The case was reviewed favorably with minor recommendations noted, such as additional notes for the facilitator and stronger alignment between objectives and critical actions expected. Both surveys asked for demographic information and an evaluation of the case on a scale of 1-5, with 5 being the highest rating. Learners ranked the case 4.5, and then 4.8 on iterative trialing sessions.  Facilitators ranked the case above 4 out of 5 for all questions. Comments centered on clarifying verbal prompts and debriefing plan.</p>\n<p>Discussion: Overall, this standardized patient case for patient communication was received positively and is recommended for use in preparation for the ABEM certifying examination.</p>","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Patient-centered communication"},{"word":"threatened miscarriage"},{"word":"Health Communication"}],"section":"Certifying Exam Practice","is_remote":false,"remote_url":"https://jetem.org/pcc_miscarriage/","frozenauthors":[{"first_name":"Anita","middle_name":"","last_name":"Rohra","name_suffix":"","institution":"Baylor College of Medicine","department":"Department of Emergency Medicine"},{"first_name":"Daniela","middle_name":"","last_name":"Ortiz","name_suffix":"","institution":"Baylor College of Medicine","department":"Department of Emergency Medicine"},{"first_name":"Shagun","middle_name":"","last_name":"Berry","name_suffix":"","institution":"Rush University Medical Center","department":"Department of Emergency Medicine"},{"first_name":"Colleen","middle_name":"","last_name":"Donovan","name_suffix":"","institution":"Rutgers Robert Wood Johnson Medical School","department":"Department of Emergency Medicine"},{"first_name":"Nicole","middle_name":"","last_name":"Novotny","name_suffix":"","institution":"Ochnser Health System","department":"Department of Emergency Medicine"},{"first_name":"Stephanie","middle_name":"","last_name":"Cohen","name_suffix":"","institution":"University of Central Florida","department":"Department of Emergency Medicine"},{"first_name":"Charles","middle_name":"","last_name":"Lei","name_suffix":"","institution":"Hennepin County Medical Center","department":"Department of Emergency Medicine"},{"first_name":"Alaa","middle_name":"","last_name":"Aldalati","name_suffix":"","institution":"University of Kansas School of Medicine-Wichita","department":"Wesley Medical Center Emergency Department"},{"first_name":"Stephanie","middle_name":"","last_name":"Stapleton","name_suffix":"","institution":"Boston University/Boston Medical Center","department":"Department of Emergency Medicine"},{"first_name":"David","middle_name":"","last_name":"Fernandez","name_suffix":"","institution":"Mount Sinai Hospital","department":"Department of Emergency Medicine"}],"date_submitted":"2025-07-22T22:01:28+03:00","date_accepted":"2025-12-08T22:58:28.559000+03:00","date_published":"2025-12-31T23:08:00+03:00","render_galley":{"label":"Rohra A, et al. Patient Centered Communication Case Threatened Miscarriage. JETem 2025. 10(5)CE58-76","type":"pdf","path":"https://journalpub.escholarship.org/uciem_jetem/article/52360/galley/47799/download/"},"galleys":[{"label":"Rohra A, et al. Patient Centered Communication Case Threatened Miscarriage. JETem 2025. 10(5)CE58-76","type":"pdf","path":"https://journalpub.escholarship.org/uciem_jetem/article/52360/galley/47799/download/"}]}