a Department of Medicine, Long Island Jewish Forest Hills , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health System , Forest Hills , NY , USA.
b Faculty Development , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health System , Hempstead , NY , USA.
Med Educ Online. 2018 Dec;23(1):1527627. doi: 10.1080/10872981.2018.1527627.
We have challenges with poor patient satisfaction scores (Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]) and internal medicine resident (IMR) evaluations of voluntary attending physicians. Using an Observed Structured Teaching Encounter (OSTE), we designed a faculty development project that focused on attendings' teaching and feedback skills. To assess attending communication with interns and improve attending teaching and feedback skills. All IM attendings on the Long Island Jewish Forest Hills (LIJFH) Emergency Department (ED) call schedule participated. OSTE simulation sessions included two clinical scenarios, standardized patients (SPs), fourth-year medical students trained as 'interns,' OSTE checklists, and debriefing. We analyzed 'intern' ratings of communication with attendings and attending self-assessment during the OSTE, and attending HCAHPS scores and IMR evaluations of attendings pre- and post-OSTE. Twenty-nine of 29 attendings completed the OSTE. Although an increase was demonstrated pre- to post- for 'intern' OSTE ratings of attendings and LIJFH attending self-assessment ratings, there was no statistically significant difference. Mean HCAHPS scores and resident evaluations of attendings also increased from pre- (22% and 3.59) to post-OSTE (30% and 3.87) but did not reach statistical significance. A statistically significant difference for both cases was demonstrated when comparing mean attending self-assessment ratings with 'intern' evaluation of attendings. Attending teaching/feedback skills improved between cases, attending self-ratings were higher than 'intern' ratings of attendings. HCAHPS and IMR evaluations of attendings improved post-OSTE. Regular intervention utilizing an OSTE may provide a sustained benefit for enhancing attendings' skills, patient satisfaction, and resident training.
我们面临着患者满意度评分（医院消费者评估医疗保健提供者和系统[HCAHPS]）和内科住院医师（IMR）对志愿主治医生的评估不佳的挑战。我们使用观察结构化教学遭遇（OSTE）设计了一个专注于主治医生教学和反馈技能的教师发展项目。评估主治医生与住院医师的沟通情况，并提高主治医生的教学和反馈技能。长岛犹太森林山（LIJFH）急诊部（ED）的所有内科主治医生都参加了这个项目。OSTE 模拟课程包括两个临床场景、标准化患者（SP）、作为“住院医师”培训的四年级医学生、OSTE 检查表和汇报。我们分析了“住院医师”在 OSTE 中对主治医生沟通的评价以及主治医生在 OSTE 期间的自我评估，以及主治医生在 OSTE 前后的 HCAHPS 评分和 IMR 对主治医生的评估。29 名主治医生完成了 OSTE。尽管“住院医师”在 OSTE 前后对主治医生的评价以及 LIJFH 主治医生自我评估的评分有所提高，但没有统计学意义。HCAHPS 评分和住院医师对主治医生的评价也从 OSTE 前（22%和 3.59）增加到 OSTE 后（30%和 3.87），但没有达到统计学意义。当比较主治医生的自我评估评分与“住院医师”对主治医生的评价时，两个案例都显示出统计学上的显著差异。主治医生的教学/反馈技能在案例之间有所提高，主治医生的自我评分高于“住院医师”对主治医生的评分。OSTE 后主治医生的 HCAHPS 和 IMR 评估有所提高。定期利用 OSTE 进行干预可能会为提高主治医生的技能、患者满意度和住院医师培训提供持续的益处。
