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沟通至关重要:一项关于妇产科住院医师培训中沟通教学法的调查研究

Communication Matters: a Survey Study of Communication Didactics in Obstetrics/Gynecology Residency.

作者信息

Howell Elizabeth P, Fischer Jonathan, Valea Fidel A, Davidson Brittany A

机构信息

Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC USA.

Department of Family Medicine and Community Health, Duke University, Durham, NC USA.

出版信息

Med Sci Educ. 2020 Jun 30;30(3):1069-1076. doi: 10.1007/s40670-020-01017-9. eCollection 2020 Sep.

Abstract

BACKGROUND

Delivery of excellent patient care hinges on effective communication. Improved communication between physicians, patients, and colleagues can facilitate shared decision-making and foster successful interprofessional teams. Despite the importance of this skill, little is understood about the status or acceptability of dedicated communication training during obstetrics and gynecology (OB/GYN) residency.

OBJECTIVE

To explore the national landscape of dedicated communication didactics during OB/GYN training.

METHODS

Residents and program directors (PDs) at ACGME-accredited programs were emailed anonymized surveys. Survey responses pertaining to communication didactics and trainee experiences were evaluated using descriptive statistics and chi-squared tests.

RESULTS

Of 143 PDs, 45 responded (31.5%). Although the total number of residents receiving our survey is unattainable, our 215 resident respondents can be estimated to represent at least 4.4% of trainees. 98.1% of residents reported challenging clinical communication at least monthly, with many reporting this weekly (47.9%) and daily (30.0%). A majority of PDs (77.8%) and residents (67.0%) endorsed interest in communication training. 62.2% of programs reported formally teaching communication skills. Certain topics were infrequently taught yet cited by residents as particularly challenging-such as "diffusing conflict" and "angry patient or family members." PDs tended to significantly overestimate trainee competence in conducting difficult conversations with both patients ( = 0.0003) and interdisciplinary colleagues ( < 0.0001), as compared with resident self-assessments.

CONCLUSIONS

Residents encounter frequent challenging communications interactions, and often feel inadequately equipped to navigate them. Dedicated didactics may provide a critical component to optimally educating of the next generation of trainees within OB/GYN and more broadly.

摘要

背景

提供优质的患者护理取决于有效的沟通。改善医生、患者及同事之间的沟通有助于共同决策,并促进跨专业团队的成功协作。尽管这项技能很重要,但对于妇产科住院医师培训期间专门的沟通培训的现状或可接受性了解甚少。

目的

探讨妇产科培训期间专门的沟通教学的全国情况。

方法

向美国毕业后医学教育认证委员会(ACGME)认证项目的住院医师和项目主任(PD)发送匿名调查问卷。使用描述性统计和卡方检验对与沟通教学及学员经历相关的调查回复进行评估。

结果

143名PD中,45人回复(31.5%)。虽然无法得知接收我们调查的住院医师总数,但据估计,我们的215名住院医师受访者至少占学员总数的4.4%。98.1%的住院医师报告至少每月会遇到具有挑战性的临床沟通情况,许多人报告每周(47.9%)和每天(30.0%)都会遇到。大多数PD(77.8%)和住院医师(67.0%)表示对沟通培训感兴趣。62.2%的项目报告正式教授沟通技巧。某些主题很少讲授,但住院医师认为这些主题特别具有挑战性,如“化解冲突”和“应对愤怒的患者或家属”。与住院医师的自我评估相比,PD往往显著高估学员与患者(P = 0.0003)和跨学科同事(P < 0.0001)进行艰难对话的能力。

结论

住院医师经常遇到具有挑战性的沟通互动,并且常常觉得自己没有足够的能力应对。专门的教学可能为妇产科及更广泛领域的下一代学员的最佳教育提供关键组成部分。

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