Olson Maren E, Borman-Shoap Emily, Mathias Karen, Barnes Timothy L, Olson Andrew P J
Department of Medical Education, Children's Hospitals and Clinics of Minnesota, 347 North Smith Ave, Mailstop 70-103, Saint Paul, MN 55102, USA.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
Diagnosis (Berl). 2018 Nov 27;5(4):243-248. doi: 10.1515/dx-2018-0025.
Background Uncertainty is ubiquitous in medical practice. The Pediatrics Milestones from the Accreditation Council on Graduate Medical Education state that advanced learners should acknowledge and communicate about clinical uncertainty. If uncertainty is not acknowledged, patient care may suffer. There are no described curricula specifically aimed to improve learners' ability to acknowledge and discuss clinical uncertainty. We describe an educational intervention designed to fill this gap. Methods Second-year pediatric residents engaged in a two-phase simulation-based educational intervention designed to improve their ability to communicate about diagnostic uncertainty with patients and caregivers. In each phase, residents engaged in two simulated cases and debriefs. Performance was assessed after each simulated patient encounter using standardized metrics, along with learner perceptions of the experience. Results Residents' skills in communicating with patients and families about diagnostic uncertainty improved after this intervention (mean score post 3.84 vs. 3.28 pre on a five-point Likert scale, p<0.001). Residents rated the experience as relevant, challenging and positive. Conclusions This prospective study suggests that a simulation-based intervention was effective in improving resident physicians' skills in communicating about diagnostic uncertainty with patients and families. Further study is needed to determine how learners perform in real clinical environments.
背景
不确定性在医疗实践中普遍存在。研究生医学教育认证委员会的《儿科学里程碑》指出，进阶学习者应认识到临床不确定性并就此进行沟通。如果不承认不确定性，患者护理可能会受到影响。目前尚无专门旨在提高学习者认识和讨论临床不确定性能力的课程描述。我们描述了一种旨在填补这一空白的教育干预措施。
方法
二年级儿科住院医师参与了一个两阶段的基于模拟的教育干预，旨在提高他们与患者及护理人员就诊断不确定性进行沟通的能力。在每个阶段，住院医师参与两个模拟病例及病例汇报。在每次模拟患者接触后，使用标准化指标评估表现，并收集学习者对该经历的看法。
结果
经过此次干预，住院医师与患者及家属就诊断不确定性进行沟通的技能有所提高（在五点李克特量表上，干预后平均得分为3.84，干预前为3.28，p<0.001）。住院医师对该经历的评价是相关、具有挑战性且积极的。
结论
这项前瞻性研究表明，基于模拟的干预措施在提高住院医师与患者及家属就诊断不确定性进行沟通的技能方面是有效的。需要进一步研究以确定学习者在实际临床环境中的表现。
