Fiorentino Michele, Mosenthal Anne C, Bryczkowski Sarah, Lamba Sangeeta
Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
J Palliat Med. 2021 Jan;24(1):77-82. doi: 10.1089/jpm.2020.0076. Epub 2020 Jul 21.
Traumatic events are sudden, unexpected, and often devastating. The delivery of difficult news to patients and families in the trauma setting has unique challenges that necessitate communication skills that may differ from those used in other clinical environments. Design and implement a novel curriculum to teach, assess, and provide feedback to trauma residents on the communication skills necessary for delivering difficult news to patients and families in the trauma setting. This communication curriculum was delivered in three separate phases: (1) didactics using a video education e-module, (2) simulated practice of trauma resuscitation with a high-fidelity mannequin followed by role play of delivering difficult news, (3) an observed skills assessment using standardized patients (SPs). Each phase focused on delivery of difficult news of death and of uncertain/poor prognosis after a resuscitation in the trauma bay. Learners were trauma residents that included postgraduate year (PGY) 1-2 general surgery residents and PGY 1-4 emergency medicine residents at a level 1 trauma center. Outcomes include resident comfort, knowledge, and confidence in delivering difficult news in the trauma setting. Thirty-nine trauma residents participated in the three-phase curriculum. There was an increase in the mean scores of resident-reported comfort, knowledge, and confidence in delivering difficult news for the seriously injured. SPs rated 78% of residents as competent to perform delivery of difficult news in the trauma bay independently. A curriculum to teach and assess trauma residents in the skills necessary to deliver difficult news in the trauma setting is both feasible and effective.
创伤性事件是突然发生、出乎意料且往往具有毁灭性的。在创伤环境中向患者及其家属传达坏消息面临着独特的挑战，这需要具备与其他临床环境中所使用的不同的沟通技巧。设计并实施一门新颖的课程，向创伤科住院医师传授、评估并提供反馈，内容涉及在创伤环境中向患者及其家属传达坏消息所需的沟通技巧。该沟通课程分三个阶段进行：（1）使用视频教育电子模块进行理论教学；（2）使用高仿真人体模型模拟创伤复苏过程，随后进行传达坏消息的角色扮演；（3）通过标准化病人（SP）进行观察技能评估。每个阶段都聚焦于在创伤病房传达复苏后死亡以及不确定/预后不良的坏消息。学习者为创伤科住院医师，包括一级创伤中心的1 - 2年级普通外科住院医师和1 - 4年级急诊医学住院医师。结果包括住院医师在创伤环境中传达坏消息时的舒适度、知识水平和信心。39名创伤科住院医师参加了这个三阶段课程。住院医师报告的在为重伤患者传达坏消息时的舒适度、知识水平和信心的平均得分有所提高。标准化病人将78%的住院医师评定为有能力在创伤病房独立传达坏消息。一门教授和评估创伤科住院医师在创伤环境中传达坏消息所需技能的课程是可行且有效的。
