Chiarchiaro Jared, Schuster Rachel A, Ernecoff Natalie C, Barnato Amber E, Arnold Robert M, White Douglas B
1 Division of Pulmonary, Allergy, and Critical Care Medicine.
Ann Am Thorac Soc. 2015 Apr;12(4):526-32. doi: 10.1513/AnnalsATS.201411-495OC.
Although medical simulation is increasingly being used in healthcare education, there are few examples of how to rigorously design a simulation to evaluate and study important communication skills of intensive care unit (ICU) clinicians.
To use existing best practice recommendations to develop a medical simulation to study conflict management in ICUs, then assess the feasibility, acceptability, and realism of the simulation among ICU clinicians.
The setting was a medical ICU of a tertiary care, university hospital. Participants were 36 physicians who treat critically ill patients: intensivists, palliative medicine specialists, and trainees. Using best-practice guidelines and an iterative, multidisciplinary approach, we developed and refined a simulation involving a critically ill patient, in which the patient had a clear advance directive specifying no use of life support, and a surrogate who was unwilling to follow the patient's preferences. ICU clinicians participated in the simulation and completed surveys and semistructured interviews to assess the feasibility, acceptability, and realism of the simulation.
All participants successfully completed the simulation, and all perceived conflict with the surrogate (mean conflict score, 4.2 on a 0-10 scale [SD, 2.5; range, 1-10]). Participants reported high realism of the simulation across a range of criteria, with mean ratings of greater than 8 on a 0 to 10 scale for all domains assessed. During semistructured interviews, participants confirmed a high degree of realism and offered several suggestions for improvements.
We used existing best practice recommendations to develop a simulation model to study physician-family conflict in ICUs that is feasible, acceptable, and realistic.
尽管医学模拟在医疗保健教育中的应用日益广泛，但关于如何严格设计模拟以评估和研究重症监护病房（ICU）临床医生重要沟通技巧的实例却很少。
利用现有的最佳实践建议开发一种医学模拟，以研究ICU中的冲突管理，然后评估该模拟在ICU临床医生中的可行性、可接受性和逼真度。
研究地点为一所三级医疗大学医院的医学ICU。参与者为36名治疗重症患者的医生：重症监护医生、姑息医学专家和实习生。我们采用最佳实践指南和迭代多学科方法，开发并完善了一个涉及重症患者的模拟，该患者有明确的预先指示，指明不使用生命支持，还有一位不愿遵循患者意愿的代理人。ICU临床医生参与模拟，并完成调查问卷和半结构化访谈，以评估模拟的可行性、可接受性和逼真度。
所有参与者均成功完成模拟，且所有人都察觉到与代理人存在冲突（冲突评分均值，0至10分制下为4.2分[标准差，2.5；范围，1至10]）。参与者报告称，该模拟在一系列标准上具有高度逼真度，在所有评估领域的0至10分制平均评分均大于8分。在半结构化访谈中，参与者确认了高度的逼真度，并提出了一些改进建议。
我们利用现有的最佳实践建议开发了一个模拟模型，用于研究ICU中医生与家属之间的冲突，该模型可行、可接受且逼真。
