Quest Tammie E, Otsuki J Alan, Banja John, Ratcliff Jonathan J, Heron Sheryl L, Kaslow Nadine J
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Acad Emerg Med. 2002 Nov;9(11):1326-33. doi: 10.1111/j.1553-2712.2002.tb01595.x.
To design, implement, and evaluate a multi-dimensional, interdisciplinary, educational training module that enables residents to deliver an effective and empathic death disclosure in the emergency setting. The Accreditation Council for Graduate Medical Education (ACGME) "Toolbox of Assessment Methods" to assess competency was adopted as the foundation of this project.
Sixteen emergency medicine residents, eight postgraduate year 1 (PGY-1) and eight PGY-2, underwent a one-day training and evaluation exercise. The exercise consisted of: 1) a large-group didactic session, 2) a small-group didactic session, and 3) two standardized patient (SP) examinations. Changes in comfort levels, training helpfulness, and competency were measured. Inter-rater agreement between evaluators was examined.
Trainees reported improvement in comfort levels and high levels of satisfaction regarding the helpfulness of the training. Good interrater agreement was obtained regarding resident competency to perform a death disclosure between the faculty and SP evaluators [kappa 0.61; 95% confidence interval (95% CI) = 0.33 to 0.88]. However, overall agreement among raters was poor (kappa 0.16; standard error = 0.26). This poor agreement reflected a lack of agreement between resident and SP evaluators (kappa 0.08; 95% CI = 0.16 to 0.33) and resident and faculty evaluators (kappa -0.02; 95% CI = 0.30 to 0.26).
This project used the ACGME "Toolbox of Assessment Methods" to evaluate the competency of emergency medicine trainees to perform an effective and empathic death disclosure. The finding of inconsistent competency assessments by resident self-evaluators compared with those assessments made by faculty and standardized patients have important implications in future curricular design.
设计、实施并评估一个多维度、跨学科的教育培训模块，使住院医师能够在急诊环境中进行有效且富有同理心的死亡告知。本项目采用研究生医学教育认证委员会（ACGME）的“评估方法工具箱”来评估能力，以此作为项目基础。
16名急诊医学住院医师，8名一年级住院医师（PGY - 1）和8名二年级住院医师（PGY - 2），参加了为期一天的培训和评估活动。该活动包括：1）大型讲座课程，2）小组讲座课程，以及3）两次标准化病人（SP）检查。测量舒适度、培训帮助程度和能力的变化。检查评估者之间的评分者间一致性。
学员报告称舒适度有所提高，对培训的帮助程度满意度较高。在教师和标准化病人评估者之间，就住院医师进行死亡告知的能力达成了良好的评分者间一致性（kappa值为0.61；95%置信区间[95%CI]=0.33至0.88）。然而，评估者之间的总体一致性较差（kappa值为0.16；标准误差=0.26）。这种较差的一致性反映出住院医师与标准化病人评估者之间缺乏一致性（kappa值为0.08；95%CI=0.16至0.33）以及住院医师与教师评估者之间缺乏一致性（kappa值为 - 0.02；95%CI=0.30至0.26）。
本项目使用ACGME的“评估方法工具箱”来评估急诊医学学员进行有效且富有同理心的死亡告知的能力。与教师和标准化病人的评估相比，住院医师自我评估者对能力评估不一致的结果对未来课程设计具有重要意义。
