Brown Crystal E, Back Anthony L, Ford Dee W, Kross Erin K, Downey Lois, Shannon Sarah E, Curtis J Randall, Engelberg Ruth A
1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA.
2 Division of Medical Oncology, Department of Medicine, Seattle Cancer Care Alliance, University of Washington and Fred Hutchinson Cancer Research Center, Seattle WA, USA.
Am J Hosp Palliat Care. 2018 Jan;35(1):45-51. doi: 10.1177/1049909116681972. Epub 2016 Dec 14.
We conducted a randomized trial of a simulation-based multisession workshop to improve palliative care communication skills (Codetalk). Standardized patient assessments demonstrated improved communication skills for trainees receiving the intervention; however, patient and family assessments failed to demonstrate improvement. This article reports findings from trainees' self-assessments.
To examine whether Codetalk resulted in improved self-assessed communication competence by trainees.
Trainees were recruited from the University of Washington and the Medical University of South Carolina. Internal medicine residents, medicine subspecialty fellows, nurse practitioner students, or community-based advanced practice nurses were randomized to Codetalk, a simulation-based workshop, or usual education. The outcome measure was self-assessed competence discussing palliative care needs with patients and was assessed at the start and end of the academic year. We used robust linear regression models to predict self-assessed competency, both as a latent construct and as individual indicators, including randomization status and baseline self-assessed competency.
We randomized 472 trainees to the intervention (n = 232) or usual education (n = 240). The intervention was associated with an improvement in trainee's overall self-assessment of competence in communication skills ( P < .001). The intervention was also associated with an improvement in trainee self-assessments of 3 of the 4 skill-specific indicators-expressing empathy, discussing spiritual issues, and eliciting goals of care.
Simulation-based communication training was associated with improved self-assessed competency in overall and specific communication skills in this randomized trial. Further research is needed to fully understand the importance and limitations of self-assessed competence in relation to other outcomes of improved communication skill.
我们开展了一项基于模拟的多环节工作坊以提高姑息治疗沟通技巧（Codetalk）的随机试验。标准化患者评估显示接受干预的学员沟通技巧有所提高；然而，患者及家属评估未显示出改善。本文报告学员自我评估的结果。
探讨Codetalk是否能使学员自我评估的沟通能力得到提高。
从华盛顿大学和南卡罗来纳医科大学招募学员。将内科住院医师、医学专科研究员、执业护士学生或社区高级执业护士随机分为Codetalk组（基于模拟的工作坊）或常规教育组。结局指标是自我评估与患者讨论姑息治疗需求的能力，并在学年开始和结束时进行评估。我们使用稳健线性回归模型预测自我评估能力，既作为一个潜在结构，也作为个体指标，包括随机分组状态和基线自我评估能力。
我们将472名学员随机分为干预组（n = 232）或常规教育组（n = 240）。干预与学员对沟通技巧能力的总体自我评估改善相关（P < .001）。干预还与学员对4项特定技能指标中的3项——表达同理心、讨论精神问题和引出护理目标——的自我评估改善相关。
在这项随机试验中，基于模拟的沟通培训与总体及特定沟通技巧的自我评估能力提高相关。需要进一步研究以充分理解自我评估能力相对于沟通技巧改善的其他结果的重要性和局限性。
