Supe A N
KEM Hospital, Parel, Mumbai, Maharashtra, India.
Educ Health (Abingdon). 2011 Dec;24(3):541. Epub 2011 Dec 12.
Communicating bad news to patients and families is an essential skill for physicians but can be difficult for interns. Very little is known about skills in this area for interns in developing countries.
Two focus groups, consisting of a total of 12 interns, were conducted in the Seth G.S. Medical College and KEM Hospital in Mumbai, India. The grounded theory approach was used to identify common themes and concepts, which related to: (1) barriers in communicating bad news, (2) interns' confidence in communicating bad news, (3) interns' perceptions about their need for such training and (4) interns' suggested methods for training.
Interns described barriers in time constraints, language, their personal fears, patients' illiteracy, crowded wards with no privacy and lack of training. All interns lacked confidence in breaking news of death, but seven were confident in breaking bad news about chronic diseases or cancers. Subjects reported they had received very little classroom teaching or formal instruction in this area, though they had had opportunities to observe a few instances of breaking bad news. They expressed need for increased focus on communication skills curriculum in the form of case discussions, workshops and small group teaching, in addition to clinical observation.
Interns in our school in Mumbai reported inadequate training and low comfort and skill in communicating bad news and expressed need for focused training.
向患者及其家属传达坏消息是医生的一项基本技能，但对于实习医生来说可能具有挑战性。对于发展中国家的实习医生在这方面的技能了解甚少。
在印度孟买的塞思·G.S.医学院和KEM医院进行了两个焦点小组讨论，共有12名实习医生参与。采用扎根理论方法来确定与以下方面相关的共同主题和概念：（1）传达坏消息的障碍，（2）实习医生传达坏消息的信心，（3）实习医生对这类培训需求的认知，以及（4）实习医生建议的培训方法。
实习医生描述了时间限制、语言、个人恐惧、患者文盲、病房拥挤无隐私以及缺乏培训等障碍。所有实习医生在告知死亡消息时都缺乏信心，但有7人对告知慢性病或癌症等坏消息有信心。受试者报告称，他们在这方面很少接受课堂教学或正规指导，尽管他们有机会观察过一些传达坏消息的情况。他们表示，除了临床观察外，还需要以病例讨论、工作坊和小组教学等形式，更加注重沟通技能课程。
我们在孟买学校的实习医生报告称，在传达坏消息方面培训不足，舒适度和技能较低，并表示需要针对性的培训。
