运用教学客观结构化临床考试（OSCE）促使学习者与谈论宗教和/或灵性的患者接触。

Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality.

机构信息

Dr. Ledford is assistant professor, Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Seehusen is program director, NCC-Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, Virginia. Mrs. Canzona is a PhD student, Department of Communication, George Mason University, Fairfax, Virginia. Ms. Cafferty is research associate, Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

出版信息

Acad Med. 2014 Jan;89(1):60-5. doi: 10.1097/ACM.0000000000000062.

DOI:10.1097/ACM.0000000000000062

PMID:24280851

Abstract

PURPOSE

The objective structured clinical examination (OSCE) has only occasionally been used as a teaching tool. The authors describe the initial use of an educational innovation consisting of a teaching OSCE used as "sensitizing practice," followed by personal, guided, and group reflection.

METHOD

Staff and resident physicians and one medical student (N = 28) at a community hospital's family medicine residency participated in the innovation during August 2012. The initial use of the educational innovation allowed learners to engage in a potentially challenging conversation with a standardized patient about religion and/or spirituality (R/S). The aim of the innovation was not to equip learners with a particular tactic to introduce or discuss R/S but, rather, to prompt learners to engage in mindful practice with patients who identify R/S as part of their biopsychosocial contexts. Written, dyadic, and group reflection added value to the OSCE by allowing participants to reflect on a difficult learning objective over time.

RESULTS

Participants moved along the stages-of-change continuum when engaging in guided reflection compared with personal reflection. Additionally, all participants provided evidence of at least the preparation stage at the time of guided reflection. By following the OSCE's sensitizing practice with three periods of reflection, learners were enabled first, to recognize the need for readiness to address challenging communication topics (in this case, R/S) and, second, to reflect on practiced strategies for those conversations.

CONCLUSIONS

The educational innovation can help learners become more aware of and skillful in dealing with difficult physician-patient communication topics.

摘要

目的

客观结构化临床考试（OSCE）仅偶尔被用作教学工具。作者描述了一种教育创新的初步应用，该创新由作为“敏感实践”的教学 OSCE 组成，随后是个人、指导和小组反思。

方法

2012 年 8 月，一家社区医院的家庭医学住院医师项目的工作人员、住院医师和一名医学生（N=28）参与了这项创新。该教育创新的初步应用使学习者能够与标准化患者就宗教和/或精神问题（R/S）进行潜在具有挑战性的对话。该创新的目的不是让学习者掌握一种特别的策略来介绍或讨论 R/S，而是促使学习者与将 R/S 视为其生物心理社会背景一部分的患者进行有意识的实践。书面、双人小组和小组反思通过允许参与者随着时间的推移对困难的学习目标进行反思，为 OSCE 增加了价值。