Caffery Terrell S, D'Antonio Claude, Pogue Debbra, Musso Mandi W
Emergency Medicine Residency Program, Louisiana State University Health Sciences Center, School of Medicine, Baton Rouge Campus, Baton Rouge, LA.
Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA.
Ochsner J. 2022 Spring;22(1):43-47. doi: 10.31486/toj.21.0086.
The growing regulatory and hospital focus on patient experience and patient satisfaction is evidenced by the Centers for Medicare and Medicaid Services implementation of Hospital Value-Based Purchasing and by the Accreditation Council for Graduate Medical Education milestones. However, there is a paucity of data examining the education and evaluation of emergency medicine residents' nontechnical skills (eg, communication and situational awareness) as they relate to patient interactions. The purpose of the current study was to evaluate a nontechnical skills rating tool with emergency medicine residents during their interactions with patients. As part of the educational initiative, the authors consulted with a hospitality training and measurement company, the Freeman Group, that developed and trained faculty on the use of an observational tool to assess physicians' nontechnical skills. Nontechnical skills were assessed in 4 domains designated by the acronym C.A.R.E.: with the patient, the interaction to meet patient needs, patient requests, and with the patient. Faculty observed emergency medicine residents as they interacted clinically with patients in the emergency department and rated them on a binary scale: acceptable or unacceptable. Thirty-four of 36 residents were observed. Our study demonstrates that the residents performed very well on domains of empathy, adjusting to patients' knowledge, and resolving requests. However, residents' abilities to customize conversations to patients (eg, addressing patients appropriately and establishing and maintaining rapport) were rated as unacceptable 31% of the time. Overall, residents performed well on most aspects of nontechnical skills observed during their interactions with patients. However, even when residents were mindful of faculty observing nontechnical skills, they performed unacceptably in their communication with patients in approximately one-third of the interactions. This study provides important insight into nontechnical skill areas that may be influenced with intervention to improve patient interactions, and ultimately, influence patient satisfaction.
医疗保险和医疗补助服务中心实施的医院价值导向型采购以及毕业后医学教育认证委员会的里程碑事件，都证明了监管机构和医院对患者体验及患者满意度的日益关注。然而，关于急诊医学住院医师非技术技能（如沟通和情境意识）与患者互动相关的教育和评估的数据却很匮乏。本研究的目的是在急诊医学住院医师与患者互动期间评估一种非技术技能评级工具。作为教育倡议的一部分，作者咨询了一家酒店培训和测量公司——弗里曼集团，该公司开发并培训教员使用一种观察工具来评估医生的非技术技能。非技术技能在由首字母缩写词C.A.R.E.指定的四个领域进行评估：与患者、满足患者需求的互动、患者请求以及与患者。教员观察急诊医学住院医师在急诊科与患者进行临床互动时的表现，并以二元尺度对他们进行评级：可接受或不可接受。36名住院医师中有34名被观察。我们的研究表明，住院医师在同理心、根据患者知识进行调整以及解决请求等领域表现非常出色。然而，住院医师根据患者定制对话的能力（如恰当地称呼患者以及建立和维持融洽关系）在31%的时间里被评为不可接受。总体而言，住院医师在与患者互动期间观察到的非技术技能的大多数方面表现良好。然而，即使住院医师意识到教员在观察非技术技能，他们在大约三分之一的互动中与患者沟通时表现仍不可接受。这项研究为非技术技能领域提供了重要见解，这些领域可能会受到干预的影响，以改善患者互动，并最终影响患者满意度。
