Vaidya V U, Greenberg L W, Patel K M, Strauss L H, Pollack M M
Department of Critical Care Medicine, Children's National Medical Center, Washington, DC 20010, USA.
Arch Pediatr Adolesc Med. 1999 Apr;153(4):419-22. doi: 10.1001/archpedi.153.4.419.
To evaluate the effectiveness of a training program using standardized parents (SPs) to improve the performance of pediatric intensive care fellows in communicating bad news to parents.
Self-controlled crossover design.
Tertiary pediatric intensive care unit in a university-affiliated children's hospital.
Seven pediatric intensive care fellows and 4 trained volunteers (2 sets of SPs) participated in the study.
Two case scenarios of children admitted to the intensive care unit with a near-fatal diagnosis were used for the fellow's interactions with the SPs. The SPs had received 15 hours of training in role playing, performance evaluation, and giving feedback to the physicians. At the end of the first session, SPs provided feedback to the physicians under each of the 5 following categories: communication skills, content issues, support systems, interventions, and parent perceptions. During the second session, the parent meeting was repeated with a new but similar case scenario and a different set of SPs. Both sessions were videotaped, and a rater blinded to the order of the sessions used a weighted scale based on a checklist to score changes in physician performance.
The performance by the fellows showed a significant mean (+/-SEM) improvement in scores of 18.1 (+/-5.2) points (P = .007) between the first and the second sessions. Ranking of session scores revealed that physician performance improved significantly during the second session (Wilcoxon signed rank test, P = .002).
To our knowledge this is the first study that demonstrates short-term improvement in physician performance in conveying bad news in a pediatric intensive care setting using SPs in a 1-day workshop.
评估使用标准化家长（SPs）的培训项目对提高儿科重症监护进修医生向家长传达坏消息能力的有效性。
自我对照交叉设计。
一所大学附属医院的三级儿科重症监护病房。
7名儿科重症监护进修医生和4名经过培训的志愿者（2组标准化家长）参与了该研究。
使用两个重症监护病房收治的患有近乎致命诊断疾病儿童的病例场景，让进修医生与标准化家长进行互动。标准化家长接受了15小时的角色扮演、绩效评估及向医生提供反馈方面的培训。在第一次培训结束时，标准化家长根据以下5个类别向医生提供反馈：沟通技巧、内容问题、支持系统、干预措施和家长看法。在第二次培训期间，针对一个新的但类似的病例场景和另一组标准化家长重复进行家长会议。两次培训均进行录像，一名对培训顺序不知情的评分者根据一份清单使用加权量表对医生表现的变化进行评分。
进修医生的表现显示，第一次和第二次培训之间的平均得分显著提高（+/-标准误）18.1（+/-5.2）分（P = .007）。培训得分排名显示，医生在第二次培训期间表现显著改善（Wilcoxon符号秩检验，P = .002）。
据我们所知，这是第一项表明在为期1天的研讨会上，使用标准化家长能使儿科重症监护环境中医生传达坏消息的表现得到短期改善的研究。
