Assistant Professor, Department of Pediatrics, Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine.
Education Resource Specialist, Clinical Skills Education and Assessment Center, The Ohio State University College of Medicine.
MedEdPORTAL. 2021 Mar 4;17:11120. doi: 10.15766/mep_2374-8265.11120.
Child neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents.
We developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience.
Nine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%).
We implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.
由于复杂的疾病具有广泛的预后和治疗方法，儿童神经病学在沟通方面存在独特的挑战。有效的沟通可以通过刻意练习和指导来教授。客观结构化临床考试（OSCE）是提供练习和评估沟通技巧的一种方法。然而，针对儿童神经病学住院医师的 OSCE 尚未有报道。
我们为儿童神经病学住院医师开发了以沟通技能为中心的模拟临床病例，这些病例都具有具有挑战性的临床情景（例如，披露医疗错误、心因性非癫痫发作事件）。标准化患者（SP）扮演儿科患者的父母，在某些情况下，还扮演青少年患者。我们使用改良的“差距-卡拉马祖沟通技能评估表”来评估沟通技能。评估由教师、SP 和住院医师完成，并测量评分者之间的一致性。住院医师在评估后被调查他们的体验。
开发并试点了 9 个案例。在三个年度实施中，总共进行了 27 次独特的住院医师与案例的接触，涉及 16 名个体学员。360 度沟通技能评估的得分表明，与其他评分者相比，住院医师普遍低估了自己的技能。在 18 份 OSCE 后调查的回复中，大多数（77%）认为该体验对他们的教育有用，并认为 SP 的反馈是有帮助的（61%），病例描绘是现实的（89%）。
我们为儿童神经病学住院医师实施了模拟病例，以评估和提供沟通技能的形成性反馈。我们为其他项目开发这项教育活动提供了蓝图。
