Indiana University School of Medicine, Indianapolis, Indiana, USA.
Indiana University School of Nursing, Indianapolis, Indiana, USA.
Clin Teach. 2020 Dec;17(6):644-649. doi: 10.1111/tct.13170. Epub 2020 May 30.
Death notification can be challenging for emergency medicine physicians, who have no prior established relationship with the patient or their families. The GRIEV_ING death notification curriculum was developed to facilitate the delivery of the bad news of a patient's death and has been shown to improve learners' confidence and competence in death notification. Rapid-cycle deliberate practice (RCDP), a facilitator-guided, within-event debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment. The aim of this study was to identify whether the use of this technique is an effective method of teaching the GRIEV_ING curriculum, as demonstrated by learners' improved confidence, cognitive knowledge and performance. Rapid-cycle deliberate practice (RCDP), a facilitator-guided within-event, debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment METHODS: A 4-hour pilot curriculum was developed to educate and assess residents on the delivery of death notification. The curriculum consisted of a pre-intervention evaluation, the intervention phase, and a post-intervention evaluation. The cognitive test, critical action checklist, and self-efficacy/confidence surveys were identical for both pre- and post-intervention evaluations. A Wilcoxon rank-sum test was used to evaluate differences in scores between pre- and post-intervention groups.
Twenty-two emergency medicine residents participated in the study. We observed an increase in median self-efficacy scores (4.0 [4.0-5.0], p ≤ 0.0001), multiple-choice GRIEV_ING scores (90.0 [80.0-90.0], p ≤ 0.0001) and performance scores for death notification (48.5 [47.0-53.0], p = 0.0303).
The RCDP approach was found to be an effective method to train emergency medicine residents in the delivery of the GRIEV_ING death notification curriculum. This approach is actionable with few resources except for content experts trained in RCDP methodology and the application of the GRIEV_ING mnemonic.
对于没有与患者或其家属事先建立关系的急诊医师来说，通知死亡可能具有挑战性。GRIEV_ING 死亡通知课程的开发旨在促进传递患者死亡的坏消息，并已证明可以提高学习者在死亡通知方面的信心和能力。快速循环刻意练习（RCDP）是一种由指导者引导的、事件内的讨论技术，已证明可提高学习者在安全学习环境中的技能。本研究的目的是确定该技术是否是教授 GRIEV_ING 课程的有效方法，方法是通过学习者的信心、认知知识和表现的提高来证明。快速循环刻意练习（RCDP）是一种由指导者引导的、事件内的讨论技术，已证明可提高学习者在安全学习环境中的技能。
制定了 4 小时的试点课程，以教育和评估居民进行死亡通知。课程包括干预前评估、干预阶段和干预后评估。认知测试、关键行动清单和自我效能/信心调查在干预前和干预后评估中是相同的。使用 Wilcoxon 秩和检验来评估干预前和干预后组之间分数的差异。
22 名急诊医学住院医师参加了研究。我们观察到自我效能得分中位数增加（4.0 [4.0-5.0]，p≤0.0001），GRIEV_ING 多项选择得分（90.0 [80.0-90.0]，p≤0.0001）和死亡通知绩效得分（48.5 [47.0-53.0]，p=0.0303）。
发现 RCDP 方法是培训急诊医学住院医师进行 GRIEV_ING 死亡通知课程的有效方法。这种方法是可行的，只需很少的资源，除了经过 RCDP 方法培训的内容专家和 GRIEV_ING 助记符的应用外。
