Lifchez Scott D, Redett Richard J
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Surg Educ. 2014 May-Jun;71(3):297-301. doi: 10.1016/j.jsurg.2013.09.010. Epub 2014 Jan 1.
Teaching and assessing professionalism and interpersonal communication skills can be more difficult for surgical residency programs than teaching medical knowledge or patient care, for which many structured educational curricula and assessment tools exist. Residents often learn these skills indirectly, by observing the behavior of their attendings when communicating with patients and colleagues. The purpose of this study was to assess the results of an educational curriculum we created to teach and assess our residents in professionalism and communication.
We assessed resident and faculty prior education in delivering bad news to patients. Residents then participated in a standardized patient (SP) encounter to deliver bad news to a patient's family regarding a severe burn injury. Residents received feedback from the encounter and participated in an education curriculum on communication skills and professionalism. As a part of this curriculum, residents underwent assessment of communication style using the Myers-Briggs type inventory. The residents then participated in a second SP encounter discussing a severe pulmonary embolus with a patient's family.
Resident performance on the SP evaluation correlated with an increased comfort in delivering bad news. Comfort in delivering bad news did not correlate with the amount of prior education on the topic for either residents or attendings. Most of our residents demonstrated an intuitive thinking style (NT) on the Myers-Briggs type inventory, very different from population norms.
The lack of correlation between comfort in delivering bad news and prior education on the subject may indicate the difficulty in imparting communication and professionalism skills to residents effectively. Understanding communication style differences between our residents and the general population can help us teach professionalism and communication skills more effectively. With the next accreditation system, residency programs would need to demonstrate that residents are acquiring these skills in their training. SP encounters are effective in teaching and assessing these skills.
对外科住院医师培训项目而言,教授和评估职业素养及人际沟通技巧可能比教授医学知识或患者护理更具挑战性,因为针对后者存在许多结构化的教育课程和评估工具。住院医师通常通过观察带教老师与患者及同事沟通时的行为来间接学习这些技能。本研究的目的是评估我们创建的一个教育课程的效果,该课程旨在教授和评估住院医师的职业素养及沟通能力。
我们评估了住院医师和教员此前向患者传达坏消息方面的教育情况。住院医师随后参与了一次标准化患者(SP)会诊,就严重烧伤向患者家属传达坏消息。住院医师从会诊中获得反馈,并参与了关于沟通技巧和职业素养的教育课程。作为该课程的一部分,住院医师使用迈尔斯 - 布里格斯性格分类法接受沟通风格评估。住院医师随后参与了第二次SP会诊,与患者家属讨论严重肺栓塞问题。
住院医师在SP评估中的表现与传达坏消息时舒适度的提高相关。传达坏消息时的舒适度与住院医师或教员此前在该主题上的教育量无关。我们的大多数住院医师在迈尔斯 - 布里格斯性格分类法中表现出直觉思维风格(NT),与总体标准差异很大。
传达坏消息时的舒适度与该主题此前的教育之间缺乏相关性,这可能表明有效地向住院医师传授沟通和职业素养技能存在困难。了解我们的住院医师与一般人群之间的沟通风格差异有助于我们更有效地教授职业素养和沟通技能。随着下一次认证体系的实施,住院医师培训项目需要证明住院医师在培训中正在获得这些技能。标准化患者会诊在教授和评估这些技能方面是有效的。