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针对妇产科住院医师开展围手术期不良事件告知的沟通教学法的实施情况

The Implementation of Communication Didactics for OB/GYN Residents on the Disclosure of Adverse Perioperative Events.

作者信息

Chung Esther H, Truong Tracy, Jooste Karen R, Fischer Jonathan E, Davidson Brittany A

机构信息

Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.

Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina.

出版信息

J Surg Educ. 2021 May-Jun;78(3):942-949. doi: 10.1016/j.jsurg.2020.09.001. Epub 2020 Sep 26.

Abstract

OBJECTIVE

Communication skills are key components of the patient-physician relationship, yet are not routinely taught during residency. Institutional data demonstrates 75% of residents regularly encounter difficult communication scenarios. This study's objective is to develop and pilot a communications didactic/skills training program for Obstetrics & Gynecology (OB/GYN) residents focused on the disclosure of adverse perioperative events.

DESIGN

This was an observational, prospective cohort pilot study. OB/GYN residents completed a 4-hour interactive curriculum using VitalTalk methodology, certified facilitators, and simulated patients in 2019. Participants completed self-assessments of their skill levels at 3 time points: prior to training, immediately post-training, 3-month post-training. Wilcoxon signed rank tests were used to evaluate change in skill levels.

SETTING

University-based program in North Carolina.

PARTICIPANTS

Participants included all OB/GYN residents from postgraduate years 1-4. Out of 31 residents, 27 participated in the training, 24 completed the immediately post-training survey, and 23 completed the 3-month post-training survey.

RESULTS

At baseline, most residents rated their global skill level in communication as novice (37.0%) or advanced beginner (33.3%). Immediately following the intervention, 41.7% of residents ranked their global skill as "competent" and 20.8% as "proficient." These changes were statistically significant (p < 0.001). Notable improvements were seen across multiple variables, including the handling of emotional reactions (p = 0.046). No significant changes were noted between the immediately post-training and 3-month time points, suggesting skill retention. Majority of trainees (78.3%) felt that refresher courses would be useful for skill maintenance.

CONCLUSION

A simulation-based formalized communication curriculum is effective for improving OB/GYN resident competence and skill levels in the disclosure of adverse perioperative events. Specific to adverse surgical complications, this curriculum appears feasible for implementation by other training programs. Further work is needed to identify the most beneficial timing and modality of these workshops.

摘要

目的

沟通技巧是医患关系的关键组成部分,但在住院医师培训期间并非常规教学内容。机构数据显示,75%的住院医师经常遇到沟通困难的情况。本研究的目的是为妇产科住院医师开发并试行一个侧重于围手术期不良事件披露的沟通教学/技能培训项目。

设计

这是一项观察性前瞻性队列试点研究。2019年,妇产科住院医师使用VitalTalk方法、认证培训师和模拟患者完成了一个4小时的互动课程。参与者在3个时间点完成了对自己技能水平的自我评估:培训前、培训后立即、培训后3个月。使用Wilcoxon符号秩检验来评估技能水平的变化。

地点

北卡罗来纳州的大学项目。

参与者

参与者包括所有1-4年级的妇产科住院医师。31名住院医师中,27名参加了培训,24名完成了培训后立即进行的调查,23名完成了培训后3个月的调查。

结果

在基线时,大多数住院医师将自己的整体沟通技能水平评为新手(37.0%)或高级初学者(33.3%)。干预后立即,41.7%的住院医师将自己的整体技能评为“胜任”,20.8%评为“熟练”。这些变化具有统计学意义(p<0.001)。在多个变量上都有显著改善,包括对情绪反应的处理(p=0.046)。在培训后立即和3个月时间点之间未发现显著变化,表明技能得以保留。大多数受训者(78.3%)认为复习课程对技能维持有用。

结论

基于模拟的正规沟通课程对于提高妇产科住院医师在围手术期不良事件披露方面的能力和技能水平是有效的。针对手术不良并发症,该课程对其他培训项目而言似乎可行。需要进一步开展工作来确定这些工作坊最有益的时间安排和形式。

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