Shaw Andrew C, McQuade Jennifer L, Reilley Matthew J, Nixon Burke, Baile Walter F, Epner Daniel E
Texas Oncology, 1401 Medical Parkway, Cedar Park, TX, 78613, USA.
University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
J Cancer Educ. 2019 Dec;34(6):1198-1203. doi: 10.1007/s13187-018-1428-3.
Oncology training focuses primarily on biomedical content rather than psychosocial content, which is not surprising in light of the enormous volume of technical information that oncology fellows assimilate in a short time. Nonetheless, the human connection, and specifically communication skills, remains as important as ever in caring for highly vulnerable patients with cancer. We previously described a year-long communication skills curriculum for oncology fellows that consisted of monthly 1-hour seminars with role play as the predominant teaching method (Epner and Baile, Acad Med. 89:578-84, 2014). Over several years, we adapted the curriculum based on learner feedback and reflection by faculty and teaching assistants and consolidated sessions into quarterly 3-4-hour workshops. We now describe integrating stories into the curriculum as a way of building empathy and warming fellows to the arduous task of dealing with highly emotional content, such as conversations with young patients about transitioning off disease-directed therapy. Learners read and discussed published, medically themed stories; discussed their own patient care stories; and completed brief writing reflections and discussions. They then worked in small groups facilitated by faculty and upper level fellows who functioned as teaching assistants to work on applying specific skills and strategies to scenarios that they chose. Fellows completed anonymous surveys on which they rated the curriculum highly for relevance, value, organization, content, and teaching methods, including storytelling aspects. We conclude that sharing stories can help highly technical learners build reflective ability, mindfulness, and empathy, which are all critical ingredients of the art of medicine.
肿瘤学培训主要侧重于生物医学内容而非心理社会内容,鉴于肿瘤学住院医师在短时间内要吸收大量的技术信息,出现这种情况并不奇怪。尽管如此,在照顾身患癌症的极度脆弱患者时,人与人之间的联系,尤其是沟通技巧,仍然一如既往地重要。我们之前描述了一项针对肿瘤学住院医师的为期一年的沟通技巧课程,该课程包括每月一次的1小时研讨会,主要教学方法是角色扮演(埃普纳和贝利,《学术医学》。89:578 - 84, 2014)。多年来,我们根据学习者的反馈以及教员和助教的反思对课程进行了调整,并将课程合并为每季度一次的3 - 4小时工作坊。我们现在描述将故事融入课程,以此作为一种培养同理心的方式,并让住院医师对处理高度情绪化内容(比如与年轻患者讨论停止针对疾病的治疗)这项艰巨任务做好准备。学习者阅读并讨论已发表的、以医学为主题的故事;讨论他们自己的患者护理故事;并完成简短的写作反思和讨论。然后,他们在由教员和担任助教的高年级住院医师推动的小组中工作,将特定的技能和策略应用到他们选择的场景中。住院医师完成了匿名调查,在调查中他们对课程的相关性、价值、组织、内容和教学方法(包括讲故事的方面)给予了高度评价。我们得出结论,分享故事有助于高度专业化的学习者培养反思能力、正念和同理心,而这些都是医学艺术的关键要素。