Levy Carly, Diaz Maria Carmen G, Dickerman Mindy
General Pediatrics/Palliative Medicine, Nemours Children's Health/Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, USA.
General Pediatrics/Emergency Medicine, Nemours Children's Health/Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, USA.
Cureus. 2022 Jun 2;14(6):e25597. doi: 10.7759/cureus.25597. eCollection 2022 Jun.
Objective In this study, we aimed to develop and pilot a mixed-methods curriculum among pediatric subspecialty fellows that combined didactics, role-play, and bedside coaching with a procedure card. We hypothesized that this curriculum would improve fellows' ability to navigate difficult conversations and would be feasible to implement across training programs. Methods This study was conducted from 2019 to 2020. Phase 1 focused on establishing baseline performance. Phase 2 involved the education of participants and faculty. During phase 3, participants communicated difficult news to patients and families using the procedure card as a prompt with the aid of faculty coaching. Six months later, participants' performance was re-evaluated and compared with baseline performance. Results A total of 10 out of 17 (60%) participants completed the pilot study. Likert self-efficacy results revealed an improvement in the skill of delivering difficult news (3.0 pre-intervention, 4.1 post-intervention, p=0.0001), conducting a family conference (2.5 pre-intervention, 3.6 post-intervention, p=0.0001), and responding to emotions (3.4 pre-intervention, 4.2 post-intervention, p=0.0003). Investigator assessments showed improvement in fellows' ability to communicate information clearly (2.5 pre-intervention, 3.9 post-intervention, p=0.0001) and demonstrate empathy (2.7 pre-intervention, 3.3 post-intervention, p=0.005). Conclusions In this pilot study, coaching at the bedside with a procedure-card prompt was effective at improving specific self-perceived and observed communication skills. Future research is needed to evaluate modifications to this curriculum to enhance its feasibility.
目的 在本研究中，我们旨在为儿科亚专科住院医师开发并试行一种混合方法课程，该课程将教学、角色扮演、床边指导与操作卡片相结合。我们假设该课程将提高住院医师应对艰难对话的能力，并且在各个培训项目中实施是可行的。方法 本研究于2019年至2020年进行。第一阶段侧重于建立基线表现。第二阶段涉及对参与者和教员的培训。在第三阶段，参与者在教员指导下，以操作卡片为提示，向患者及其家属传达坏消息。六个月后，对参与者的表现进行重新评估，并与基线表现进行比较。结果 17名参与者中有10名（60%）完成了试点研究。李克特自我效能结果显示，在传达坏消息的技能方面有提高（干预前3.0，干预后4.1，p=0.0001），在召开家庭会议方面有提高（干预前2.5，干预后3.6，p=0.0001），在应对情绪方面有提高（干预前3.4，干预后4.2，p=0.0003）。研究者评估显示住院医师在清晰传达信息的能力方面有提高（干预前2.5，干预后3.9，p=0.0001），在表现同理心方面有提高（干预前2.7，干预后3.3，p=0.005）。结论 在这项试点研究中，借助操作卡片提示在床边进行指导有效地提高了特定的自我感知和观察到的沟通技能。需要进一步的研究来评估对该课程的修改，以提高其可行性。
