Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, Le Kremlin Bicêtre, France.
Unité de Psycho-Oncologie, Institut Gustave Roussy, F- 94800, Villejuif, France.
J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):102062. doi: 10.1016/j.jogoh.2021.102062. Epub 2021 Jan 13.
Disclosure of damage related to care is a difficult area of communication due to the physician's feeling of guilt or the fear of liability. The aim of this study was to develop, and to evaluate the impact of an inter-disciplinary simulation program on communication of damage related to care.
Residents in gynecology/obstetrics and anesthesiology participated in role-playing scenarios of communication of damage related to care. We assessed verbal, non-verbal communication skills and inter-disciplinary relations with a modified SPIKES protocol and with a video analysis with predefined indicators. We evaluated long-term impact of the training at 3-6 months with combining self-assessment and a video analysis on retained knowledge.
We included 80 residents in 15 sessions of simulation. Satisfaction regarding the simulation training was high (9.1/10 [8.9-9.3]). The part of the SPIKES protocol "setting up the interview" was the more difficult to apply. Empathic attitude was adopted 80 % of the time in the two scenarios with a life-threatening complication but was less common in the anesthetic one (broken tooth). The residents found interdisciplinary disclosure helpful due to support from the other resident. Immediately after the session, residents reported an important improvement in communication skills and that the session would significantly change their practice. At 3-6 months, reports were still largely positive but less than on immediate evaluation.
Residents did not master the most important communication skills. The interdisciplinary method to breaking bad news was felt useful.
由于医生的内疚感或对责任的恐惧，披露与护理相关的损害是沟通的一个困难领域。本研究的目的是开发一种跨学科模拟方案，并评估其对与护理相关的损害沟通的影响。
妇产科和麻醉科的住院医师参与了与护理相关的损害沟通的角色扮演场景。我们使用改良的 SPIKES 方案和带有预定义指标的视频分析评估言语、非言语沟通技巧和跨学科关系。我们在 3-6 个月时通过自我评估和视频分析相结合来评估培训的长期影响，以评估保留的知识。
我们共纳入了 15 次模拟培训的 80 名住院医师。模拟培训的满意度很高（9.1/10 [8.9-9.3]）。SPIKES 方案中“访谈准备”部分的应用较为困难。在两个危及生命的并发症情景中，住院医师采取了 80%的同理心态度，但在麻醉情景中（断牙）则不常见。住院医师发现跨学科披露有助于从其他住院医师那里获得支持。培训结束后，住院医师立即报告沟通技巧有了显著提高，并表示培训将极大地改变他们的实践。在 3-6 个月时，报告仍然主要是积极的，但不如即时评估时那么积极。
住院医师并未掌握最重要的沟通技巧。跨学科的方法来传递坏消息被认为是有用的。
