1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.
2 Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, MA.
AJR Am J Roentgenol. 2017 Aug;209(2):351-357. doi: 10.2214/AJR.16.17439. Epub 2017 May 24.
The purpose of this study was to develop and test a standardized communication skills assessment instrument for radiology.
The Delphi method was used to validate the Kalamazoo Communication Skills Assessment instrument for radiology by revising and achieving consensus on the 43 items of the preexisting instrument among an interdisciplinary team of experts consisting of five radiologists and four nonradiologists (two men, seven women). Reviewers assessed the applicability of the instrument to evaluation of conversations between radiology trainees and trained actors portraying concerned parents in enactments about bad news, radiation risks, and diagnostic errors that were video recorded during a communication workshop. Interrater reliability was assessed by use of the revised instrument to rate a series of enactments between trainees and actors video recorded in a hospital-based simulator center. Eight raters evaluated each of seven different video-recorded interactions between physicians and parent-actors.
The final instrument contained 43 items. After three review rounds, 42 of 43 (98%) items had an average rating of relevant or very relevant for bad news conversations. All items were rated as relevant or very relevant for conversations about error disclosure and radiation risk. Reliability and rater agreement measures were moderate. The intraclass correlation coefficient range was 0.07-0.58; mean, 0.30; SD, 0.13; and median, 0.30. The range of weighted kappa values was 0.03-0.47; mean, 0.23; SD, 0.12; and median, 0.22. Ratings varied significantly among conversations (χ = 1186; p < 0.0001) and varied significantly by viewing order, rater type, and rater sex.
The adapted communication skills assessment instrument is highly relevant for radiology, having moderate interrater reliability. These findings have important implications for assessing the relational competencies of radiology trainees.
本研究旨在开发和测试一种标准化的放射科沟通技巧评估工具。
采用德尔菲法，通过对现有的 43 项放射科 Kalamazoo 沟通技巧评估工具进行修订，并在由五名放射科医生和四名非放射科医生（两名男性，七名女性）组成的跨学科专家团队中就这些项目达成共识，从而对该工具进行验证。评估者评估了该工具在评估放射科住院医师与扮演焦虑父母的专业演员之间关于坏消息、辐射风险和诊断错误的沟通模拟场景中的适用性。使用修订后的工具对在沟通研讨会期间录制的视频中记录的住院医师与演员之间的一系列模拟场景进行了评估，以评估该工具的评分者间信度。八位评估者对在医院模拟中心录制的七段不同的医生与父母演员之间的视频记录进行了评估。
最终工具包含 43 个项目。经过三轮评审，43 个项目中有 42 个（98%）项目对有关坏消息的沟通的评价为相关或非常相关。所有项目对有关错误披露和辐射风险的沟通的评价均为相关或非常相关。可靠性和评分者间一致性测量为中度。组内相关系数范围为 0.07-0.58；平均值为 0.30；标准差为 0.13；中位数为 0.30。加权 Kappa 值范围为 0.03-0.47；平均值为 0.23；标准差为 0.12；中位数为 0.22。不同场景之间的评分存在显著差异（χ = 1186；p < 0.0001），并且评分还因观看顺序、评分者类型和评分者性别而异。
经过改编的沟通技巧评估工具与放射科高度相关，具有中度的评分者间信度。这些发现对评估放射科住院医师的人际关系能力具有重要意义。
