Srisarajivakul Nalinee, Lucero Catherine, Wang Xiao-Jing, Poles Michael, Gillespie Colleen, Zabar Sondra, Weinshel Elizabeth, Malter Lisa
Nalinee Srisarajivakul, Michael Poles, Colleen Gillespie, Sondra Zabar, Elizabeth Weinshel, Lisa Malter, Division of Gastroenterology, VA New York Harbor Healthcare System, New York, NY 10010, United States.
World J Gastroenterol. 2017 May 14;23(18):3315-3321. doi: 10.3748/wjg.v23.i18.3315.
To assess first-year gastroenterology fellows' ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).
Two OSCEs ("distracted care team" and "frazzled intern") were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows' ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows' performances. The fellows completed a self-assessment survey.
Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the "distracted care team" case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the "frazzled intern" case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored "well done" in a domain that focused on allowing the intern to think through the case with the fellow's guidance.
Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
使用客观结构化临床考试（OSCE）评估一年级胃肠病学住院医师应对工作场所中棘手人际关系状况的能力。
创建了两项OSCE（“分心的护理团队”和“疲惫的实习医生”）来评估对破坏性行为的应对。在案例1中，一名住院医师使用结肠镜检查模拟器，同时与由演员扮演的标准化患者（SP）、护士和主治医生进行互动。护士和主治医生被指示表现出特定的破坏性行为，除非被要求停止破坏性行为并专注于患者和操作，否则不理会住院医师。在案例2中，住院医师要安抚一名正在处理大量胃肠道出血患者的实习医生。两种场景的目的都是评估住院医师在应对演员表现出的破坏性行为时履行职责的能力。标准化患者使用清单对住院医师的表现进行评分。住院医师完成了一份自我评估调查。
来自四个胃肠病学住院医师培训项目的12名住院医师参加了OSCE。在“分心的护理团队”案例中，三分之一的住院医师打断了冲突并将注意力重新集中到患者身上。尽管附近讨论激烈，但一半的住院医师能够表现出专业素养。在OSCE后调查的跨专业部分，即衡量他们处理冲突能力的部分，住院医师得分最低。在“疲惫的实习医生”案例中，68%的住院医师能够与标准化患者建立冷静和专业的关系。尽管取得了这一成功，但只有一半的住院医师成功地向标准化患者传达了计划，在一个侧重于让实习医生在住院医师指导下思考病例的领域中，只有三分之一的住院医师获得“表现出色”的评价。
住院医师必须接受如何应对破坏性行为的培训。OSCE是一种可以评估住院医师技能并营造开放讨论氛围的工具。
