Lloyd G, Skarratts D, Robinson N, Reid C
Emergency Department, Southampton General Hospital.
J Accid Emerg Med. 2000 Jul;17(4):246-50. doi: 10.1136/emj.17.4.246.
To identify common weaknesses in senior house officer-patient consultation skills, and evaluate direct observation with feedback and negotiation of educational contracts, as a teaching tool in an emergency department setting.
Common weaknesses were identified through review of feedback charts by three trained observers. Alteration in clinical and learning behaviour, as well as senior house officer and observer perceptions of the teaching were evaluated qualitatively by a combination of semistructured interviews and focus groups.
Several common weaknesses were identified, notably the use of closed questions, and poor negotiation and explanation of treatment plan and follow up. The senior house officers perceived improvement in their clinical practice, welcomed feedback, and subsequently set, though did not complete educational contracts. While comfortable with this style of teaching, the observers felt that it did not make efficient use of teaching time.
This study identifies common weaknesses in the consultation skills of emergency department senior house officers and confirms the need for training in this area. Direct observation is effective in changing behaviour to this end, though self directed learning is not necessarily stimulated. Video recorded consultations with group feedback may be a more effective teaching tool.
识别住院医师与患者会诊技能中的常见薄弱环节，并评估通过反馈和协商教育合同进行直接观察，作为急诊科环境中的一种教学工具。
由三名经过培训的观察员通过审查反馈图表来识别常见薄弱环节。通过半结构化访谈和焦点小组相结合的方式，对临床和学习行为的改变以及住院医师和观察员对教学的看法进行定性评估。
识别出几个常见薄弱环节，尤其是封闭式问题的使用，以及治疗计划和随访的协商与解释不足。住院医师认为他们的临床实践有改进，欢迎反馈，并随后制定了教育合同，但未完成。虽然观察员对这种教学方式感到满意，但他们认为这种方式没有有效利用教学时间。
本研究识别出急诊科住院医师会诊技能中的常见薄弱环节，并证实了该领域培训的必要性。直接观察在为此改变行为方面是有效的，尽管不一定能激发自主学习。录像会诊并进行小组反馈可能是一种更有效的教学工具。
