Department of Pediatrics (SL Hilgenberg, AL Bogetz, and RL Blankenburg), Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, Calif.
Department of Pediatrics (SL Hilgenberg, AL Bogetz, and RL Blankenburg), Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, Calif.
Acad Pediatr. 2019 Apr;19(3):283-290. doi: 10.1016/j.acap.2018.10.005. Epub 2018 Oct 25.
Medical providers struggle when communicating with angry patients and their caregivers. Pediatric residents perceive communication competencies as an important priority for learning, yet they lack confidence and desire more training in communicating with angry families. Few curricula exist to support trainees with de-escalation skill development. We developed, implemented, and evaluated the impact of a novel de-escalation curriculum on pediatric resident communication skills.
We conducted a randomized controlled trial of a 90-minute de-escalation curriculum for pediatric residents from August to September 2016. Trained standardized patient (SP) actors rated residents' communication skills following 2 unique encounters before and after the intervention or control sessions. Residents completed a retrospective pre/post communication skills self-assessment and curriculum evaluation. We used independent and paired t-tests to assess for communication improvements.
Eighty-four of 88 (95%) eligible residents participated (43 intervention, 41 control). Residents reported frequent encounters with angry caregivers. At baseline, interns had significantly lower mean SP-rated de-escalation skills than other residents (P = .03). Intervention residents did not improve significantly more than controls on their pre/post change in mean SP-rated de-escalation skills; however, intervention residents improved significantly on their pre/post mean self-assessed de-escalation skills (P ≤ .03).
Despite significant self-assessed improvements, residents' SP-rated de-escalation skills did not improve following a skills-based intervention. Nevertheless, our study illustrates the need for de-escalation curricula focused on strategies and peer discussion, suggests optimal timing of delivery during fall of intern year, and offers an assessment tool for exploration in future studies.
医疗服务提供者在与愤怒的患者及其照顾者沟通时会感到困难。儿科住院医师认为沟通能力是学习的重要优先事项，但他们缺乏信心，并希望在与愤怒的家庭沟通方面接受更多培训。很少有课程可以支持学员发展缓和技能。我们开发、实施并评估了一种新的缓和课程对儿科住院医师沟通技巧的影响。
我们在 2016 年 8 月至 9 月期间对儿科住院医师进行了一项 90 分钟的缓和课程的随机对照试验。经过培训的标准化患者（SP）演员在干预或对照课程前后对住院医师的沟通技巧进行了 2 次独特的评估。住院医师完成了沟通技巧自我评估和课程评估的回顾性预/后评估。我们使用独立和配对 t 检验来评估沟通的改善情况。
88 名符合条件的住院医师中有 84 名（95%）参与了研究（43 名干预组，41 名对照组）。住院医师报告经常遇到愤怒的照顾者。在基线时，实习生的 SP 评分的缓和技能明显低于其他住院医师（P =.03）。干预组的住院医师在 SP 评分的缓和技能方面的预/后变化没有比对照组显著提高；然而，干预组在他们的自我评估的缓和技能方面有显著的提高（P ≤.03）。
尽管有明显的自我评估改善，但住院医师的 SP 评分的缓和技能并没有在基于技能的干预后得到改善。然而，我们的研究说明了需要有针对策略和同伴讨论的缓和课程，建议在住院医师第一年秋季进行最佳的课程交付时间，并提供了一个评估工具，以供未来研究探索。
