S.K. Martin is assistant professor of medicine and associate program director, Internal Medicine Residency Program, University of Chicago Pritzker School of Medicine, Chicago, Illinois. K. Carter is associate professor of medicine and assistant dean for admissions, University of Chicago Pritzker School of Medicine, Chicago, Illinois. N. Hellermann was a student, College of the University of Chicago, Chicago, Illinois, at the time of writing. The author is now a research assistant, Veterans Affairs Medical Center New York-Manhattan Campus, New York, New York. L.R. Glick is a third-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. S. Ngooi is research coordinator, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. M. Kachman is a second-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. J.M. Farnan is associate professor of medicine and associate dean for evaluation and continuous quality improvement, University of Chicago Pritzker School of Medicine, Chicago, Illinois. V.M. Arora is professor of medicine, assistant dean for scholarship and discovery, and director of clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Acad Med. 2018 Dec;93(12):1814-1820. doi: 10.1097/ACM.0000000000002337.
Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills.
In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE.
After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01).
The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.
在医学教育中，请求会诊的正规教育并不一致。为了解决这一差距，作者开发了咨询观察模拟临床经验（COSCE），这是一种针对实习医生的基于模拟的课程，使用 Kessler 及其同事的咨询 5C 模型来教授和评估咨询沟通技巧。
2016 年 6 月，127 名进入芝加哥大学医学 12 个住院医师培训项目的实习医生参加了 COSCE 试点。COSCE 的特点是一个关于 5C 的在线培训模块和一个面对面的模拟咨询。使用特定专业的患者病例，实习医生向教员请求电话咨询，教员使用经过验证的清单评估他们的表现。在模块和模拟之后，实习医生被调查他们在请求咨询之前和之后的准备情况。作为顾问的专科研究员在 COSCE 前后调查了咨询质量。
完成在线模块后，84%（103/122）的实习医生（103/122）准备好请求咨询，而基线时为 52%（63/122）（P<.01）。COSCE 后，96%（122/127）准备好请求咨询（P<.01）。准备情况和模拟表现与之前的经验或培训无关。超过 90%（115/127）的人表示他们会为未来的实习医生推荐 COSCE。更多的顾问描述说，居民在 COSCE 后（54%，21/39）比之前（27%，11/41，P=.01）更准备好请求咨询。
COSCE 受到好评，并且有效地为具有不同经验和培训的新进入实习医生做好了请求咨询的准备。未来的工作将强调针对培训环境的咨询沟通，并通过临床绩效的直接观察来评估技能。
