Yuan Yih Ying, Scott Susan, Van Horn Ngoc, Oke Oluwaseun, Okada Pamela
Pediatric Emergency Medicine, University of Texas Southwestern, Dallas, USA.
Miscellaneous, Chidlren's Health System of Texas, Dallas, USA.
Cureus. 2019 Jan 16;11(1):e3903. doi: 10.7759/cureus.3903.
Breaking bad news (BBN), especially in the pediatric emergency medicine department, requires significant skill and delicacy due to the acute context of a busy emergency department (ED) and the lack of prior rapport with the patients and families. Pediatric literature on breaking bad news has mostly focused on pediatric oncology and pediatric critical care, with limited literature focused on pediatric emergency medicine. Review of the literature also reveals that most existing studies solely assess the learners' self-ratings of efficacy and comfort, and far fewer studies objectively evaluate learners' actual performance using simulation. Our objectives for this study was to use an objective assessment tool to assess residents' breaking bad news skills, pre- and post-simulation training, specifically in the setting of a pediatric emergency medicine department.
34 residents were evaluated on their performance in breaking bad news via videotaped simulation encounters before and after teaching intervention. The "Modified Breaking Bad News Assessment Scale" (mBAS) was used as the assessment tool. A paired t-test analysis was conducted to examine the mean difference in pre- and post-simulation scores in each of the five mBAS domains.
Breaking bad news performance score improves one to two weeks post-intervention, and was statistically significant in three of five domains.
Our study shows that breaking bad news is a teachable skill that can be improved by simulated education in the pediatric emergency medicine department. This study demonstrates the utility of simulation course in improving breaking bad news skills in the pediatric emergency medicine department. Future work in developing focused simulation curriculums is important to improve provider communication skills and patient-physician relationships.
传递坏消息（BBN），尤其是在儿科急诊科，由于繁忙的急诊科（ED）的急性情况以及与患者及其家属缺乏先前的融洽关系，需要高超的技巧和细腻的处理。关于传递坏消息的儿科文献大多集中在儿科肿瘤学和儿科重症监护方面，而关注儿科急诊医学的文献有限。对文献的回顾还表明，大多数现有研究仅评估学习者对效能和舒适度的自我评分，而客观评估学习者使用模拟的实际表现的研究要少得多。我们这项研究的目的是使用一种客观评估工具来评估住院医师在模拟培训前后传递坏消息的技能，特别是在儿科急诊医学环境中。
通过教学干预前后的录像模拟场景对34名住院医师传递坏消息的表现进行评估。使用“改良的传递坏消息评估量表”（mBAS）作为评估工具。进行配对t检验分析，以检查五个mBAS领域中模拟前后分数的平均差异。
传递坏消息的表现分数在干预后一到两周有所提高，并且在五个领域中的三个领域具有统计学意义。
我们的研究表明，传递坏消息是一项可教授的技能，可以通过儿科急诊医学中的模拟教育得到改善。这项研究证明了模拟课程在提高儿科急诊医学中传递坏消息技能方面的效用。未来开发针对性模拟课程的工作对于提高医疗服务提供者的沟通技巧和医患关系很重要。
