Vergo Maxwell T, Sachs Sharona, MacMartin Meredith A, Kirkland Kathryn B, Cullinan Amelia M, Stephens Lisa A
Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine ,Lebanon, New Hampshire.
J Palliat Med. 2017 May;20(5):542-547. doi: 10.1089/jpm.2016.0348. Epub 2016 Nov 28.
Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed.
To assess skills acquisition and acceptability for IM residents not selecting an elective.
A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points.
SETTING/SUBJECTS: IM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation.
Pre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience.
Twelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters.
A required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.
尚未评估通过要求内科住院医师进行姑息治疗轮转来改善初级姑息治疗的沟通培训情况。
评估未选择选修课程的内科住院医师的技能获取情况和接受程度。
一组连续的单臂队列接受了以学习者为中心反馈的客观结构化临床考试（OSCE）、两周的临床经验，最后进行了一次后OSCE以明确以学习者为中心的要点。
地点/受试者：达特茅斯-希区柯克医学中心的二年级内科住院医师接受了必需的姑息治疗体验式轮转。
使用标准化评分卡对行为技能进行OSCE前后评估，包括以患者为中心的访谈、讨论护理目标/代码状态以及对情绪的反应，同时对该体验进行保密的定性和定量混合评估。
12名住院医师参与了该教育项目（2名因经历缩短被排除），在整体沟通方面有统计学显著改善，更具体地说，在讨论代码状态和对情绪的反应方面。一般以患者为中心的访谈技能没有显著提高，但轮转前的分数反映了该领域已有的能力。住院医师认为观察到的模拟临床经验（OSCE）和必需的轮转是积极的经历，但希望有更多机会在实际临床接触中练习沟通技能。
在我们机构，以OSCE为辅助的必需的姑息治疗体验式轮转，与其他非临床教育平台类似，改善了初级姑息治疗沟通技能的获取，但可能更好地满足住院医师和教员的需求，并达到ACGME所有必需的里程碑。
