明智沟通：教住院医师与患者和照护者有效沟通，避免不必要的检查。
Communicating wisely: teaching residents to communicate effectively with patients and caregivers about unnecessary tests.
机构信息
Department of Medicine, University of Toronto and Women's College Hospital Institute of Health Systems Solutions and Virtual Care, 76 Grenville Street, Room 3414, Toronto, ON, M5S 1B2, Canada.
Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
出版信息
BMC Med Educ. 2017 Dec 11;17(1):248. doi: 10.1186/s12909-017-1086-x.
BACKGROUND
With rising healthcare costs and a focus on quality, there is a growing need to promote resource stewardship in medical education. Physicians need to be able to communicate effectively with patients/caregivers seeking tests and treatments that are unnecessary. This study aimed to evaluate the impact of an interactive workshop on residents' knowledge of resource stewardship and communication skills when counseling patients/caregivers about requests for unnecessary testing.
METHODS
Participants were 83 Internal Medicine and Pediatrics residents at the University of Toronto in 2014-15. The evaluation compared resource stewardship knowledge and communication skills of 57 (69%) residents that attended the resource stewardship workshop to 26 residents (31%) who did not. Knowledge and communication skills assessment consisted of a written test and a structured assessment using standardized patient raters, respectively. A linear regression was applied to determine predictors of overall communication skills performance.
RESULTS
Workshop attendance resulted in better performance on the knowledge test (4.3 ± 1.9 vs. 3.1 ± 1.7 out of 8, p = 0.01), but not better performance on the communication skills assessment (4.1 ± 0.8 vs. 4.0 ± 0.9 out of 5, p = 0.56). Higher training level (p = 0.01) and knowledge test scores (p = 0.046) were independent predictors of better overall communication skills, after adjusting for gender, training level, workshop attendance, knowledge and self-reported prior feedback on communication skills.
CONCLUSIONS
An interactive workshop can improve knowledge of resource stewardship, but improving communication skills with patients/caregivers about unnecessary testing may require additional training or reinforcement in the clinical learning environment. These teaching and assessment approaches can support the integration of education on resource stewardship into medical education.
背景
随着医疗保健成本的上升和对质量的关注，越来越需要在医学教育中促进资源管理。医生需要能够与寻求不必要检查和治疗的患者/照顾者进行有效沟通。本研究旨在评估互动式研讨会对住院医师资源管理知识和与患者/照顾者就不必要检查请求进行咨询时沟通技巧的影响。
方法
参与者为 2014-15 年多伦多大学的 83 名内科和儿科住院医师。评估比较了参加资源管理研讨会的 57 名（69%）住院医师与未参加的 26 名（31%）住院医师的资源管理知识和沟通技巧。知识和沟通技巧评估分别包括书面测试和使用标准化患者评估者进行的结构化评估。线性回归用于确定整体沟通技巧表现的预测因素。
结果
参加研讨会可提高知识测试成绩（4.3±1.9 与 3.1±1.7，满分 8 分，p=0.01），但沟通技巧评估成绩（4.1±0.8 与 4.0±0.9，满分 5 分，p=0.56）无显著提高。调整性别、培训水平、研讨会参与、知识和自我报告的沟通技巧反馈后，更高的培训水平（p=0.01）和知识测试分数（p=0.046）是整体沟通技巧更好的独立预测因素。
结论
互动式研讨会可以提高资源管理知识，但要提高与患者/照顾者就不必要检查进行沟通的技巧，可能需要在临床学习环境中提供额外的培训或强化。这些教学和评估方法可以支持将资源管理教育纳入医学教育。
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