Assistant Professor, Department of Medicine, University of Massachusetts Medical School.
Director Faculty Development, Department of Medicine, University of Massachusetts Medical School.
MedEdPORTAL. 2021 Mar 10;17:11122. doi: 10.15766/mep_2374-8265.11122.
Goals-of-care (GOC) conversations are essential to ensure high-quality care for people with serious illness. We developed a simulation experience to train internal medicine residents in GOC conversations near end of life, followed by a real-life GOC conversation as a Mini-Clinical Evaluation Exercise (Mini-CEX) including direct feedback from participating patients.
The 3-hour simulation session trained teams of two learners each to interact with standardized patients portraying a patient with end-stage heart failure and an accompanying family member. Residents completed pre- and postsurveys regarding their self-assessed abilities and confidence in conducting these conversations. Piloted in 2016, the Mini-CEX was completed in 2017 with 28 residents 3-9 months after simulation. Patients and participating family members were invited to complete an optional, deidentified survey of their experience.
From 2015 to 2017, 84 residents completed simulation training. Ninety percent of postsurvey responders felt more prepared to conduct GOC conversations after simulation compared to 42% before training. Eighty percent or more reported confidence in discussing GOC (previously 67%), prognosis (previously 62%), and hospice (previously 49%). Analysis of Mini-CEX scores revealed that the majority of residents' skills were the same or improved compared with their performance in simulation; more than 70% demonstrated improvement in ensuring patients' comfort, displaying empathy, and recognizing/responding to emotion. Almost all patients and families reported feeling heard and satisfied with their conversation with the resident.
This curriculum was well received, and initial data support its effectiveness in enhancing residents' self-perceived confidence and interpersonal skills in real-world patient encounters.
目标关怀（GOC）对话对于确保重病患者获得高质量的护理至关重要。我们开发了一种模拟体验，以培训内科住院医师在生命末期进行 GOC 对话，然后作为迷你临床评估练习（Mini-CEX）进行现实生活中的 GOC 对话，包括来自参与患者的直接反馈。
3 小时的模拟课程培训了每队两名学员与标准化患者互动，这些患者扮演患有终末期心力衰竭的患者和一名陪同的家属。住院医师在进行预调查和调查，以评估他们在进行这些对话方面的自我评估能力和信心。该模拟课程于 2016 年进行试点，并于 2017 年在 28 名住院医师完成模拟后的 3-9 个月进行 Mini-CEX。邀请患者和参与的家属完成一份关于他们体验的可选、匿名调查。
2015 年至 2017 年期间，有 84 名住院医师完成了模拟培训。90%的事后调查参与者认为，与培训前相比，他们在模拟后更有准备进行 GOC 对话。80%或以上的人表示对讨论 GOC（以前为 67%）、预后（以前为 62%）和临终关怀（以前为 49%）有信心。对 Mini-CEX 分数的分析表明，与模拟相比，大多数住院医师的技能保持相同或有所提高；超过 70%的人在确保患者舒适、表现出同理心以及识别/回应情绪方面有所提高。几乎所有患者和家属都表示感受到了与住院医师对话的倾听和满意。
该课程受到了好评，初步数据支持其在提高住院医师在现实患者接触中的自我感知信心和人际交往技能方面的有效性。
