Sleiman Joseph, Savage David J, Switzer Benjamin, Colbert Colleen Y, Chevalier Cory, Neuendorf Kathleen, Harris David
Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Medicine, University of California San Diego Health System, San Diego, California, USA.
BMJ Simul Technol Enhanc Learn. 2021 Jun 22;7(6):568-574. doi: 10.1136/bmjstel-2021-000897. eCollection 2021.
Breaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback.
The goal of this educational innovation was to improve internal medicine residents' communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project.
Internal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges.
148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results.
A trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents' interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.
传达坏消息是住院医师至关重要的一项技能。有限的正式监督以及传达坏消息的时机不可预测，成为了有意义反馈交流的障碍。
这项教育创新的目标是在具有挑战性的传达坏消息的过程中提高内科住院医师的沟通技巧。一个正式的传达坏消息培训项目和创新的随需应变特别工作组是这个两阶段项目的一部分。
一家大型学术医疗中心的内科住院医师参加了一个聚焦于传达坏消息的互动研讨会。研讨会的调查结果作为对一个由住院医师主导的新型传达坏消息特别工作组发展的需求评估。成立特别工作组是为了在床边进行观察并在传达坏消息之后提供反馈。特别工作组成员的培训纳入了视频触发因素和一份反馈清单。在实地测试之前分析了评分者间信度，实地测试提供了关于实际实施挑战的数据。
148名住院医师在为期两小时的沟通技巧研讨会上接受了培训。根据调查结果，73%（148名中的108名）的住院医师表示参与之后在传达坏消息方面信心增强。在医院病房对特别工作组进行的实地测试揭示了住院医师请求观察时潜在的工作流程障碍，并促使进行故障排除。根据实地测试结果实施了相应解决方案。
提供一个由受训者主导的传达坏消息特别工作组和沟通技巧研讨会，作为一种在传达坏消息中提高住院医师人际和沟通技巧的创新模式。我们认为该模式具有可持续性和可重复性。提供所吸取的经验教训以帮助在其他环境中实施。
