Department of Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile, Alabama, USA.
J Surg Educ. 2013 Jan-Feb;70(1):37-47. doi: 10.1016/j.jsurg.2012.06.023. Epub 2012 Nov 10.
To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons.
Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers.
Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery).
Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified.
Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice-scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.
回顾和评估与意外和非预期患者死亡后家属/幸存者沟通相关的教育策略和形式。提出一个综合课程，旨在培养一批经验丰富的外科医生在专业经验背景下传递灾难性信息的熟练度、能力、信心和沉着。
意外和非预期的患者死亡对家属、外科医生和医疗保健提供者来说是情感和心理上的痛苦。我们之前提出，在与家属沟通之前和之后，有两个不同但相互作用的反应阶段是相关的：一个主动阶段，旨在与家属建立积极的治疗关系；一个反应阶段，旨在以同情和尊重的方式回应家属，并确保医生和医疗保健提供者的自我保健。
对一组资深外科医生（南方外科协会会员）和外科住院医师项目主任（外科项目主任协会会员）进行调查。
接受调查的 60%的资深外科医生经历过意外的患者死亡。他们提供了应对这种临床情况的策略，与研究生医学教育认证委员会的核心能力相一致：医学知识：最大限度地提供客观信息/数据，最大限度地减少主观意见；患者护理：对事件进行批评，并进行事后分析；人际沟通技巧：诚实、同理心和耐心；专业精神：以非指责的方式为家属和人员提供情感和心理支持，并保护隐私；基于实践的学习和改进：在知情同意和高级指令的背景下进行术前讨论和记录，涉及风险-效益、努力-收益和收益-负担分析；以及基于系统的实践：让牧师和医院人员参与进来。接受调查的 36%的研究生外科学教育项目据称提供了教育场所，以使外科住院医师能够应对意外的患者死亡，尽管没有具体说明形式。
研究生、毕业后和继续教育课程旨在使医生和外科医生为独立的专业实践做好准备——从科学、人文和艺术的角度。纳入使毕业生能够应对意外患者死亡带来的情绪和心理困扰的教育策略是相关的。
