Department of Pediatrics (CE Rassbach), Stanford School of Medicine (D Mahoney), Stanford, Calif.
Department of Pediatrics (AL Bogetz, C Leibold, and RL Blankenburg), Stanford School of Medicine, Palo Alto, Calif.
Acad Pediatr. 2019 Mar;19(2):186-194. doi: 10.1016/j.acap.2018.10.004. Epub 2018 Oct 24.
Despite a national focus on physician-patient communication, there is a paucity of literature on how patient and family feedback (PFF) can be used as a tool to help residents learn communication skills. The purpose of this study was to assess the effect of coaching on residents' attitudes towards PFF, self-confidence in communication, and patient-rated communication skills.
This was an institutional review board-approved, randomized-controlled trial with pediatric residents at 3 institutions from 2015 to 2016. Pre- and postintervention, residents completed a self-assessment of their attitudes and self-confidence in communication. PFF was collected for each resident using the Communication Assessment Tool, which has been validated in other medical disciplines. Intervention group residents reviewed their baseline PFF with a faculty coach; control group residents reviewed their PFF independently.
In total, 114 residents completed the study, 57 in each arm. Intervention group residents were significantly more likely to ask for PFF compared with control group residents (mean change 0.36 vs -0.11, P = .01). There were no other significant differences in resident attitudes, confidence, or patient-rated communication between groups. Both groups had increased self-confidence over time and with increasing postgraduate year level. Patient ratings of resident communication did not differ over time or between groups.
Residents who reviewed PFF with a faculty coach were significantly more likely to report they would ask patients for feedback than residents who reviewed PFF independently, suggesting review of feedback with a coach may enhance appreciation of patient feedback. Although self-confidence improved over time in both groups, patient ratings of resident communication skills were not significantly different over time or between groups.
尽管全国都关注医患沟通，但关于如何将患者和家属的反馈 (PFF) 用作帮助住院医师学习沟通技巧的工具，相关文献却很少。本研究旨在评估辅导对住院医师对 PFF 的态度、沟通自信心以及患者对沟通技巧的评价的影响。
这是一项机构审查委员会批准的、2015 年至 2016 年在 3 家机构进行的随机对照试验，涉及儿科住院医师。在干预前后，住院医师完成了对自己沟通态度和自信心的自我评估。每位住院医师都使用经过其他医学专业验证的沟通评估工具 (Communication Assessment Tool) 收集 PFF。干预组的住院医师与一名教员教练一起查看他们的基线 PFF；对照组的住院医师则独立查看他们的 PFF。
共有 114 名住院医师完成了研究，每组 57 名。与对照组相比，干预组的住院医师更有可能主动要求 PFF（平均变化 0.36 比 -0.11，P=0.01）。两组住院医师在态度、信心或患者对沟通的评价方面均无显著差异。两组住院医师的自信心都随着时间的推移和住院医年级别的增加而提高。患者对住院医师沟通的评价在时间上或组间均无差异。
与独立查看 PFF 的对照组相比，与教员教练一起查看 PFF 的住院医师更有可能报告他们会向患者寻求反馈，这表明与教练一起查看反馈可能会增强对患者反馈的重视。尽管两组住院医师的自信心都随着时间的推移而提高，但患者对住院医师沟通技巧的评价在时间上或组间均无显著差异。
