Falcone John L, Claxton René N, Marshall Gary T
University of Pittsburgh School of Medicine, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Surg Educ. 2014 May-Jun;71(3):309-15. doi: 10.1016/j.jsurg.2013.09.020. Epub 2014 Jan 2.
The objective structured clinical examination (OSCE) can be used to evaluate the Accreditation Council for Graduate Medical Education Core Competencies of Professionalism and Interpersonal and Communication Skills. The aim of this study was to describe general surgery resident performance on a "difficult conversation" OSCE.
In this prospective study, junior and senior residents participated in a 2-station OSCE. Junior stations involved discussing operative risks and benefits and breaking bad news. Senior stations involved discussing goals of care and discussing transition to comfort measures only status. Residents completed post-OSCE checklist and Likert-based self-evaluations of experience, comfort, and confidence. Trained standardized patients (SPs) evaluated residents using communication skill-based checklists and Likert-based assessments. Pearson correlation coefficients were determined between self-assessment and SP assessment. Mann-Whitney U tests were conducted between junior and senior resident variables, using α = 0.05.
There were 27 junior residents (age 28.1 ± 1.9 years [29.6% female]) and 27 senior residents (age 32.1 ± 2.5 years [26.9% female]). The correlation of self-assessment and SP assessment of overall communication skills by junior residents was -0.32 on the risks and benefits case and 0.07 on the breaking bad news case. The correlation of self-assessment and SP assessment of overall communication skills by senior residents was 0.30 on the goals of care case and 0.26 on the comfort measures only case. SP assessments showed that junior residents had higher overall communication skills than senior residents (p = 0.03). Senior residents perceived that having difficult conversations was more level appropriate (p < 0.001), and they were less nervous having difficult conversations (p < 0.01) than junior residents.
We found that residents perform difficult conversations well, that subjective and objective skills are correlated, and that skills-based training is needed across all residency levels. This well-received method may be used to observe, document, and provide resident feedback for these important skills.
客观结构化临床考试（OSCE）可用于评估毕业后医学教育认证委员会的职业素养以及人际和沟通技能等核心能力。本研究的目的是描述普通外科住院医师在“艰难对话”OSCE中的表现。
在这项前瞻性研究中，初级和高级住院医师参加了一个两站式的OSCE。初级站点涉及讨论手术风险和益处以及告知坏消息。高级站点涉及讨论护理目标以及仅讨论过渡到舒适措施状态。住院医师完成了OSCE后的检查表以及基于李克特量表的关于经验、舒适度和信心的自我评估。经过培训的标准化患者（SP）使用基于沟通技能的检查表和基于李克特量表的评估来评价住院医师。确定了自我评估与SP评估之间的皮尔逊相关系数。在初级和高级住院医师变量之间进行曼-惠特尼U检验，使用α = 0.05。
有27名初级住院医师（年龄28.1±1.9岁[29.6%为女性]）和27名高级住院医师（年龄32.1±2.5岁[26.9%为女性]）。初级住院医师在风险和益处案例中自我评估与SP对总体沟通技能评估的相关性为-0.32，在告知坏消息案例中为0.07。高级住院医师在护理目标案例中自我评估与SP对总体沟通技能评估的相关性为0.30，在仅舒适措施案例中为0.26。SP评估显示初级住院医师的总体沟通技能高于高级住院医师（p = 0.03）。高级住院医师认为进行艰难对话更符合自身水平（p < 0.001），并且他们在进行艰难对话时比初级住院医师更不紧张（p < 0.01）。
我们发现住院医师在进行艰难对话方面表现良好，主观和客观技能存在相关性，并且在所有住院医师培训水平上都需要基于技能的培训。这种广受认可的方法可用于观察、记录并为这些重要技能提供住院医师反馈。
