Posner Glenn, Nakajima Amy
Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON.
J Obstet Gynaecol Can. 2011 Mar;33(3):262-8. doi: 10.1016/s1701-2163(16)34828-9.
Disclosing adverse events to patients after a poor outcome is an essential task involving both communication skills and professionalism, but one that is difficult to teach and assess during clinical rotations. Beyond ensuring clinical competency, these skills are essential in minimizing medico-legal risk. An objective structured clinical examination (OSCE) station with a standardized patient allows an opportunity to evaluate these skills. Our objective was to assess residents' communication skills involving the disclosure of a poor outcome to a standardized patient using a standardized patient encounter, and to compare their performance before and after formal teaching on disclosure.
Fourteen obstetrics and gynaecology residents (PGY-2 to PGY-5) were evaluated in a two-station OSCE. In the first station, they obtained a history and counselled an obstetrical patient, and in the second station they met with the same patient to discuss an adverse outcome that had occurred. The residents were evaluated using guidelines for the disclosure of adverse events developed by the Canadian Patient Safety Institute and published by the Canadian Medical Protective Association. The residents then participated in a workshop on disclosure and were retested.
The mean score in the pre-workshop disclosure OSCE was 59.1% (12.4/21, SD 2.7), while the mean score in the post-workshop OSCE was 80.1% (16.9/21, SD 2.1). Using the paired Student t test, the scores differed significantly with P < 0.01.
Residents' performance in disclosure improves after formal teaching and the OSCE is an effective technique for testing communication skills.
在出现不良后果后向患者披露不良事件是一项至关重要的任务，既涉及沟通技巧又关乎专业素养，但在临床轮转期间却很难教授和评估。除了确保临床能力外，这些技能对于将医疗法律风险降至最低也至关重要。一个配备标准化患者的客观结构化临床考试（OSCE）站提供了评估这些技能的机会。我们的目的是通过标准化患者接触来评估住院医师向标准化患者披露不良后果时的沟通技巧，并比较他们在接受关于披露的正式教学前后的表现。
14名妇产科住院医师（PGY - 2至PGY - 5）在一个两站式OSCE中接受评估。在第一个站点，他们获取病史并为一名产科患者提供咨询，在第二个站点，他们与同一名患者会面讨论已发生的不良后果。使用加拿大患者安全研究所制定并由加拿大医疗保护协会发布的不良事件披露指南对住院医师进行评估。住院医师随后参加了一个关于披露的研讨会并重新接受测试。
研讨会前披露OSCE的平均分数为59.1%（12.4/21，标准差2.7），而研讨会后OSCE的平均分数为80.1%（16.9/21，标准差2.1）。使用配对学生t检验，分数差异显著，P < 0.01。
经过正式教学后，住院医师在披露方面的表现有所提高，并且OSCE是测试沟通技巧的有效方法。
