University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Surg Educ. 2022 Jul-Aug;79(4):983-992. doi: 10.1016/j.jsurg.2022.01.012. Epub 2022 Mar 1.
Best Case/Worst Case (BC/WC) is a communication tool designed to promote shared decision-making for high-risk procedures near the end of life. This study aimed to increase scalability of a BC/WC training program and measure its impact on surgeon confidence in and perceived importance of the methodology.
A prospective cohort pre-post study; December 2018 to January 2019.
Multi-center tertiary care teaching hospital.
Forty-eight resident surgeons from general surgery and otolaryngology.
Learners were 24 to 37 years old with 52% in post graduate year 1 to 2. Although learners encountered high-stakes communication (HSC) frequently (3.6 [0.7] on 5-point Likert scale), most reported no HSC training in medical school (74.5%) or residency (87.5%). BC/WC training was accomplished with an instructor to learner ratio of 1-to-5.3. After training, learner confidence improved on all measured communication skills on a 5-point scale (e.g., exploring patient's values increased from 3.6 [0.8] to 4.1 [0.6], p = <0.0001); average within-person improvement was 0.72 (0.6) points across all skills. Perceived importance improved across all skills (e.g., basing a recommendation on patient's values increased from 4.4 [0.8] to 4.8 [0.5], p = 0.0009); average within-person improvement was 0.46 (0.5) points across all skills. Learners reported this training would likely help them in future interactions (4.4 [0.73] on 5-point scale) and 95.2% recommended it be offered to resident physicians in other residency programs and to attending surgeons.
Formal training in BC/WC increases learners' perception of both the importance of HSC skills and their confidence in exercising those skills in clinical practice. VitalTalk methodology permitted scaling training to 5.3 learners per instructor and was highly recommended for other surgeons. Ongoing training, such as this, may support more patient-centered decision-making and care.
最佳情况/最差情况（BC/WC）是一种沟通工具，旨在促进生命末期高危程序的共同决策。本研究旨在提高 BC/WC 培训计划的可扩展性，并衡量其对外科医生对该方法的信心和重要性的影响。
前瞻性队列研究；2018 年 12 月至 2019 年 1 月。
多中心三级保健教学医院。
来自普通外科和耳鼻喉科的 48 名住院医师外科医生。
学习者年龄在 24 至 37 岁之间，其中 52%处于研究生第 1 至 2 年。尽管学习者经常遇到高风险沟通（HSC）（5 分制 3.6 [0.7]），但大多数人在医学院（74.5%）或住院医师（87.5%）期间没有接受过 HSC 培训。BC/WC 培训是通过 1 比 5.3 的讲师与学员比例完成的。培训后，学员在所有 5 分制测量的沟通技巧上的信心均有所提高（例如，探索患者价值观从 3.6 [0.8]增加到 4.1 [0.6]，p <0.0001）；所有技能的平均个体内改善为 0.72（0.6）点。所有技能的重要性都有所提高（例如，基于患者价值观的建议从 4.4 [0.8]增加到 4.8 [0.5]，p = 0.0009）；所有技能的平均个体内改善为 0.46（0.5）点。学习者报告说，这种培训可能会帮助他们在未来的互动中（5 分制 4.4 [0.73]），95.2%的人建议将其提供给其他住院医师计划的住院医师医生和主治外科医生。
BC/WC 的正式培训增加了学习者对高风险沟通技能的重要性以及在临床实践中运用这些技能的信心。VitalTalk 方法允许将培训扩展到每位讲师 5.3 名学员，并且强烈建议其他外科医生采用。这种持续的培训可能会支持更多以患者为中心的决策和护理。
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