Gold Coast University Hospital and Health Service, Southport, Australia.
Griffith University Institute of Educational Research and School of Medicine, Brisbane, Australia.
BMC Med Educ. 2020 Feb 11;20(1):45. doi: 10.1186/s12909-019-1922-2.
Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways.
A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives.
Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses.
Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.
在健康职业教育中，患者-临床医生、主管-学习者和促进者-参与者之间的有效沟通是一个关键优先事项。有大量的框架和建议来指导这些背景下的沟通，它们代表了具有独立实践社区和文献的不同话语。在这些框架中找到共同点有可能最小化认知负担并最大化效率，这为在沟通课程中整合信息、策略和技能提供了机会，并有可能以富有成效的方式扩展关于沟通、反馈和讨论的研究议程。
为了实现这些目标，对反馈、讨论和临床沟通文献进行了元综合分析。
我们的分析表明，框架背后的概念可以有用地分为阶段、目标、策略、微观技能和元技能。对话的指南通常具有共同的结构，而策略与一个阶段相匹配。各种类型的对话都存在核心可转移沟通技能（即微观技能），而框架之间的主要区别则与对话中权力的分配方式以及权力重新分配路径上对话的演变有关。作为综合的一部分，提出了一个总体框架“准备-授权-实施”，以捕捉这些跨话语的共同原则。
采用促进对话和授权个人做出贡献的基于工作的沟通框架可能是朝着以学习者为中心的教育和以患者为中心的护理迈出的重要一步。
