Children's Hospital of Philadelphia,Philadelphia, PA.
University of Botswana,Gaborone,Botswana.
Palliat Support Care. 2019 Feb;17(1):60-65. doi: 10.1017/S1478951518000627. Epub 2018 Oct 17.
The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news.
A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.
本研究旨在展示角色扮演在博茨瓦纳医学教育中的应用效果，以教导医学生传递坏消息。
为在哈博罗内公主玛丽娜医院轮转的博茨瓦纳大学医学生设计了一个 3 小时的小组工作坊。课程包括沟通基础概述和经过验证的（SPIKES）协议介绍，用于传递坏消息。教育策略包括讲座、讲义、角色扮演案例和公开论坛讨论。培训前后的调查评估了学生在传递坏消息方面的先前经验和方法，使用多项选择题，并使用 5 点李克特量表评估对传递坏消息的技能感知。进行了客观结构化临床考试（OSCE），并对标准化的传递坏消息技能评估进行了评估；分数比较了在实施工作坊之前和之后的两个医学生班级。
42 名医学生参加了该研讨会，83%（35/42）完成了调查。医学生报告说，他们平均每月要进行 6.9（SD=13.7）次传递坏消息的经历，其中 71%（25/35）在没有监督的情况下自行传递坏消息。在参加工作坊后，自我评估的技能和信心从 23%（8/35）增加到 86%（30/35），那些自我感觉“很好”或“非常好”能够传递坏消息的人。工作坊后的反馈表明，100%的人认为 SPIKES 方法很有帮助，并计划在临床实践中使用它，认为角色扮演很有帮助，并要求更多的课程。传递坏消息的能力从基线时的平均得分为 14/25（56%，SD=3.3）提高到工作坊后的 18/25（72%，SD=3.6）（p=0.0002）。
该工作坊有效地提高了医学生传递坏消息的技能和信心。将标准化角色扮演沟通工作坊纳入医学院课程可能是一种低成本、有效且易于实施的策略，可以提高医生的沟通技能。
