Roze des Ordons Amanda L, Doig Christopher J, Couillard Philippe, Lord Jason
A.L. Roze des Ordons is clinical assistant professor, Department of Critical Care Medicine and Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.C.J. Doig is professor, Department of Critical Care Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.P. Couillard is clinical assistant professor, Department of Critical Care Medicine and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.J. Lord is clinical associate professor, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Acad Med. 2017 Apr;92(4):501-505. doi: 10.1097/ACM.0000000000001420.
Communication with patients and families in critical care medicine (CCM) can be complex and challenging. A longitudinal curricular model integrating multiple techniques within classroom and clinical milieus may facilitate skillful communication across diverse settings.
In 2014-2015, the authors developed and implemented a curriculum for CCM fellows at the Cumming School of Medicine, University of Calgary, to promote the longitudinal development of skillful communication. A departmental needs assessment informed curriculum development. Five 4-hour classroom sessions were developed: basic communication principles, family meetings about goals and transitions of care, discussing patient safety incidents, addressing conflict, and offering organ donation. Teaching methods-including instructor-led presentations incorporating a consistent framework for approaching challenging conversations, simulation and clinical practice, and feedback from peers, trained facilitators, family members, and clinicians-supported integration of skills into the clinical setting and longitudinal development of skillful communication. Seven fellows participated during the first year of the curriculum.
CCM fellows engaged enthusiastically in the program, commented that the framework provided was helpful, and highly valued the opportunity to practice challenging communication scenarios, learn from observing their peers, and receive immediate feedback.
More detailed accounts of fellows', patients', and family members' experiences will be obtained to guide curricular development. The curriculum will be expanded to involve other members of the multidisciplinary intensive care unit team, and faculty education initiatives will be offered to enhance the quality of the feedback provided. The impact of the curriculum on initial skill development, retention, and progression will be assessed.
在危重病医学（CCM）中与患者及其家属进行沟通可能复杂且具有挑战性。一种在课堂和临床环境中整合多种技巧的纵向课程模式可能有助于在不同环境中进行有效的沟通。
2014 - 2015年，作者为卡尔加里大学卡明医学院的CCM研究员开发并实施了一门课程，以促进有效沟通技巧的纵向发展。部门需求评估为课程开发提供了依据。开发了五个4小时的课堂环节：基本沟通原则、关于护理目标和过渡的家属会议、讨论患者安全事件、处理冲突以及提供器官捐赠相关内容。教学方法包括由教师主导的讲座，讲座采用一致的框架来处理具有挑战性的对话、模拟和临床实践，以及来自同行、受过培训的协调员、家属和临床医生的反馈，这些方法支持将技能融入临床环境并促进有效沟通技巧的纵向发展。该课程第一年有七名研究员参与。
CCM研究员积极参与该项目，称所提供的框架很有帮助，高度重视有机会练习具有挑战性的沟通场景、通过观察同行学习并获得即时反馈。
将获取研究员、患者和家属更详细的经历描述以指导课程开发。该课程将扩大到多学科重症监护病房团队的其他成员，并提供教师教育举措以提高所提供反馈的质量。将评估该课程对初始技能发展、保留和进步的影响。
