L.K. Rock is a pulmonologist and critical care doctor and director, Communication and Teamwork, Critical Care Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, and she is assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-1462-1652 .
Acad Med. 2021 Nov 1;96(11):1534-1539. doi: 10.1097/ACM.0000000000004077.
Patient-provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians' ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. "Just-in-time" simulation-simulation-based training immediately before an intervention-provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients' and families' experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner's understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone's role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.
医患沟通是高质量医疗和患者安全的标志；然而，面对日益复杂的挑战，过度扩张的团队即使面对最敬业的临床医生也倍感压力。COVID-19 大流行进一步扰乱了临床医生与其患者及其家属之间的沟通。对电话沟通的依赖以及防护装备的物理障碍限制了非言语沟通，并削弱了临床医生识别和响应情绪的能力。对于那些通常负责与患者及其家属沟通的培训生来说，开发新的方法来教授沟通技巧具有挑战性，尤其是在大流行或其他危机期间。“即时”模拟——干预前的基于模拟的培训——为进行困难对话提供了培训生所需的框架和支持，并增强了患者和家属的体验。作者使用一个现实场景来说明有效使用即时模拟沟通培训的关键步骤：评估学习者对情况的理解；确定遇到的哪些方面可能最具挑战性；提供脚本作为认知辅助工具；刷新或教授特定技能；通过反思和心理演练让学习者在情感上做好准备；指导方法、节奏和语调，以传达同理心和意义；并提供具体、诚实和好奇的反馈，以缩小表现差距。此外，作者承认临床情况有时需要通过观察而不是实践来学习，因此提供了充分利用替代性观察学习的指导：在遇到的潜在挑战中明确与培训生的学习目标联系起来，解释为什么团队中更资深的成员要进行对话，让培训生观察并准备反馈，仔细选择观察地点，在对话开始时确定每个人的角色，进行反思，分享反应，并感谢培训生的反馈和观察。
