Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
J Educ Eval Health Prof. 2020;17:18. doi: 10.3352/jeehp.2020.17.18. Epub 2020 Jun 29.
According to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture.
During a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns).
Interns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001).
Interns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.
根据美国医学协会的可委托专业活动 (EPA) ，即将进入住院医师实习期的住院医师应独立为他们可能进行的程序获得知情同意。这要求住院医师不仅要告知患者，还要确保他们理解这些信息。我们评估了 2007 年至 2018 年期间在休斯顿德克萨斯大学健康科学中心的 372 名儿科实习住院医师在获取腰椎穿刺知情同意书时表现出的沟通技巧。
在一项模拟病例中，实习住院医师负责获取腰椎穿刺的知情同意书，一名标准化患者通过使用 5 分制（从“差”到“优”）对 7 项基于沟通的调查项目进行评分，对实习住院医师进行评估。然后我们将该量表转换为数字系统，并计算实习住院医师的熟练程度得分（每位住院医师的评分总和）和平均项目表现（所有实习住院医师的平均项目评分）。
实习住院医师的平均得分为 28 分满分中的 21.6 分，其中 227 名（61.0%）得分 21 或更高的实习住院医师达到了熟练程度。在实施 EPA 前后比较两个组时观察到显著差异（分别为 76.97%和 47.0%熟练）。项目水平分析表明，实习住院医师在以热情友好的方式进行就诊和鼓励患者提问方面最困难（平均评分为 2.97/4 和 2.98/4）。实习住院医师在尊重患者和积极倾听问题方面表现出色（平均评分为 3.16，各）。实施 EPA 后，平均实习住院医师熟练程度得分和平均每项得分均显著降低（P<0.001）。
实习住院医师在沟通知情同意方面表现出中等熟练程度，但仍有明显的改进空间，例如表现出热情和鼓励提问。
