Inova Fairfax Medical Campus, Division of Trauma Acute Care Surgery, Falls Church, Virginia.
George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
J Surg Educ. 2021 Jan-Feb;78(1):336-341. doi: 10.1016/j.jsurg.2020.06.018. Epub 2020 Jul 21.
Effective physician communication improves care, and many medical schools and residency programs have adopted communication focused curricula. The COVID-19 pandemic has shifted the doctor-patient communication paradigm with the rapid adoption of video-based medical appointments by the majority of the medical community. The pandemic has also necessitated a sweeping move to online learning, including teaching and facilitating the practice of communication skills remotely. We aimed to identify effective techniques for surgeons to build relationships during a video consult, and to design and pilot a class that increased student skill in communicating during a video consult.
Fourth-year medical students matched into a surgical internship attended a 2-hour class virtually. The class provided suggestions for building rapport and earning trust with patients and families by video, role play sessions with a simulated patient, and group debriefing and feedback. A group debriefing generated lessons learned and best practices for telemedicine communication in surgery.
Students felt the class introduced new skills and reinforced current ones; most reported higher self-confidence in target communication skills following the module. Students were particularly appreciative of opportunity for direct observation of skills and immediate faculty feedback, noting that the intimate setting was unique and valuable. Several elements of virtual communications required increased focus to communicate empathy and concern. Proper lighting and positioning relative to the camera were particularly important and body movement required "narration" to minimize misinterpretation. A patient's distress was more difficult to interpret; asking direct questions was recommended to understand the patient's emotional state.
There is a need to teach video-conference communication skills to enable surgical teams to build rapport in this distinct form of consultation. Our training plan appears effective at engaging learners and improving skills and confidence, and identifies areas of focus when teaching virtual communication skills.
有效的医患沟通可改善医疗服务，许多医学院校和住院医师培训计划都采用了以沟通为重点的课程。COVID-19 大流行改变了医患沟通模式，大多数医疗界迅速采用了基于视频的医疗预约。大流行还需要全面转向在线学习，包括远程教学和促进沟通技能的实践。我们旨在确定外科医生在视频咨询期间建立关系的有效技巧，并设计和试行一门课程，以提高学生在视频咨询中进行沟通的技能。
进入外科实习的四年级医学生通过虚拟方式参加了 2 小时的课程。该课程提供了通过视频与患者和家属建立融洽关系并赢得其信任的建议，与模拟患者进行角色扮演，并进行小组讨论和反馈。小组讨论产生了远程医疗沟通方面的经验教训和最佳实践。
学生们认为该课程介绍了新的技能并增强了现有的技能；大多数学生报告说，在完成该模块后，他们在目标沟通技能方面的自信心更高。学生特别赞赏有机会直接观察技能并获得教师的即时反馈，他们指出，这种亲密的环境是独特且有价值的。虚拟沟通的几个要素需要更加集中注意力来传达同理心和关心。适当的照明和相对于摄像机的位置特别重要，身体运动需要“说明”以最小化误解。患者的痛苦更难解释；建议直接提问以了解患者的情绪状态。
需要教授视频会议沟通技巧，使外科团队能够以这种独特的咨询形式建立融洽关系。我们的培训计划似乎有效地吸引了学习者，提高了技能和信心，并确定了教授虚拟沟通技巧时的重点领域。
