Lamba Sangeeta, Nagurka Roxanne, Offin Michael, Scott Sandra R
Rutgers University, New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey.
West J Emerg Med. 2015 Mar;16(2):344-52. doi: 10.5811/westjem.2015.1.24147. Epub 2015 Mar 12.
The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship.
We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma) with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why) to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections.
A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17%) and poor prognosis (34/120, 29%). This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much) for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real) generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure.
A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and competence in communicating difficult news of death and poor prognosis to family. Educators may need to seek ways to address the strong emotions generated in learners with real and simulated patient resuscitations.
目的是描述一个结构化沟通模块的实施情况及结果，该模块用于补充急诊医学实习中基于病例的模拟复苏培训。
我们在两个基于病例的模拟复苏场景（心脏骤停和钝器伤）中加入角色扮演，以教导医学生如何向危重伤病模拟患者的家属传达死亡消息和预后不良的消息。通过实习前后的调查评估定量结果。其次，学生完成一份书面自我反思（进展顺利的事情及原因；进展不顺利的事情及原因），以进一步探索学习者在复苏沟通方面的经历。定性分析从书面自我反思中确定主题。
共有120名医学生完成了实习前后的调查。大多数受访者表示他们曾目睹或参与过传达坏消息的角色扮演，但只有少数人有传达死亡消息（20/120，17%）和预后不良消息（34/120，29%）的实际经验。这个沟通模块在传达死亡和预后不良的坏消息方面，在舒适度、信心和知识方面导致了统计学上显著的分数提高。对于同意关于传达预后不良消息的陈述（有点/非常同意）的人，实习前后的分数有所提高：舒适度从69%提高到81%，信心从66%提高到81%，知识从76%提高到90%；对于关于传达死亡消息的陈述也是如此：舒适度从52%提高到68%，信心从57%提高到76%，知识从76%提高到90%。受访者报告说，患者复苏（模拟和/或真实）引发了各种强烈的情绪反应，如焦虑、压力、悲伤以及失落和失败感。
一个结构化沟通模块补充了急诊医学实习中的模拟复苏培训，并导致自我报告的在向家属传达死亡和预后不良的坏消息方面的知识、舒适度和能力的增加。教育工作者可能需要寻求方法来处理学习者在真实和模拟患者复苏中产生的强烈情绪。
