Marsh Melanie C, Reed Suzanne M, Mahan John D, Schneider Lydia, Fernandes Ashley K, Liao Nancy, Spears Isaac, Lauden Stephanie
Nationwide Children's Hospital, Columbus, OH, USA.
The Ohio State University College of Medicine, Columbus, OH, USA.
J Med Educ Curric Dev. 2021 Oct 4;8:23821205211035239. doi: 10.1177/23821205211035239. eCollection 2021 Jan-Dec.
Medical educators juggle competing demands as they seek to integrate medical advancements and new technology with the call for earlier introduction to clinical experiences. Newer models of medical education place even greater emphasis on the importance of deliberate training of providers who can deliver compassionate patient-centered care. The need for adaptable, effective communication skills training has never been more relevant than now, in our high-tech and ever-evolving learning climate.
At a large pediatric academic center, we used Kern's six-step approach to complete a needs assessment, identify goals and learning preferences of trainees, and ultimately develop and evaluate a multimodal communication curriculum. This curriculum was rooted in the Accreditation Council for Graduate Medical Education's Pediatric Milestones, with the goal of enhancing knowledge, skills, and competency. Pediatric interns were randomized to either the new curriculum ( = 19) or the existing didactic-based communication training ( = 17) from 2019 to 2020. We evaluated the impact of the new and traditional curriculum through evaluations by expert facilitators, learner surveys, and faculty-assigned resident milestones.
Many trainees self-identified performance gaps in communication skills at baseline. Eighteen residents attended 1 to 6 in-person deliberate practice workshops. Workshop participation by the residents varied over time due to a variety of factors. All residents, regardless of curricular exposure, showed statistically significant improvement in communication milestones from first to second year and those enrolled in the deliberate practice curriculum highly valued the workshops and coaching.
Our curriculum demonstrates the value of deliberate practice opportunities for residents to gain skills in advanced communication. Residents appreciated this type of training and the time devoted to expand these skills. Lessons learned and barriers to implementation from this curriculum can be helpful for educators interested in integrating active, deliberate practice, simulation-based communication training into their current educational model.
医学教育工作者在努力将医学进展和新技术与更早引入临床经验的要求相结合时，面临着相互竞争的需求。更新的医学教育模式更加注重对能够提供富有同情心的以患者为中心的护理的提供者进行刻意培训的重要性。在我们这个高科技且不断发展的学习环境中，对适应性强、有效的沟通技能培训的需求比以往任何时候都更加迫切。
在一家大型儿科教学中心，我们采用克恩的六步法完成了一项需求评估，确定了学员的目标和学习偏好，并最终开发和评估了一门多模式沟通课程。该课程以毕业后医学教育认证委员会的儿科里程碑为基础，目标是提高知识、技能和能力。2019年至2020年，儿科实习生被随机分为新课程组（n = 19）或现有的基于讲授的沟通培训组（n = 17）。我们通过专家辅导员的评估、学习者调查和教师指定的住院医师里程碑来评估新老课程的影响。
许多学员在基线时自我认定在沟通技能方面存在表现差距。18名住院医师参加了1至6次面对面的刻意练习工作坊。由于各种因素，住院医师参加工作坊的情况随时间有所不同。所有住院医师，无论课程接触情况如何，从第一年到第二年在沟通里程碑方面都有统计学上的显著改善，参加刻意练习课程的住院医师高度重视这些工作坊和辅导。
我们的课程展示了为住院医师提供刻意练习机会以获得高级沟通技能的价值。住院医师赞赏这种培训方式以及为扩展这些技能所投入的时间。从该课程中学到的经验教训和实施过程中的障碍，可能对有兴趣将积极、刻意练习、基于模拟的沟通培训融入其当前教育模式的教育工作者有所帮助。
