Departments of Surgery and Internal Medicine, Virginia Commonwealth University, Richmond, VA.
School of Medicine, Virginia Commonwealth University, Richmond, VA.
Surgery. 2022 Nov;172(5):1323-1329. doi: 10.1016/j.surg.2022.06.010. Epub 2022 Aug 23.
Before the COVID-19 pandemic, teaching communication skills in health care focused primarily on developing skills during face-to-face conversation. Even experienced clinicians were unprepared for the transition in communication modalities necessitated due to physical distancing requirements and visitation restrictions during the COVID-19 pandemic. We aimed to develop and pilot a comprehensive video-mediated communication training program and test its feasibility in multiple institutional settings and medical disciplines.
The education team, consisting of clinician-educators in general surgery and emergency medicine (EM) and faculty specialists in simulation and coaching, created the intervention. Surgery and EM interns in addition to senior medical students applying in these specialties were recruited to participate. Three 90-minute sessions were offered focusing on 3 communication topics that became increasingly complex and challenging: breaking bad news, goals of care discussions, and disclosure of medical error. This was a mixed-methods study using survey and narrative analysis of open comment fields.
Learner recruitment varied by institution but was successful, and most (75%) learners found the experience to be valuable. All of the participants reported feeling able to lead difficult discussions, either independently or with minimal assistance. Only about half (52%) of the participants reported feeling confident to independently disclose medical error subsequent to the session.
We found the program to be feasible based on acceptability, demand, the ability to implement, and practicality. Of the 3 communication topics studied, confidence with disclosure of medical error proved to be the most difficult. The optimal length and structure for these programs warrants further investigation.
在 COVID-19 大流行之前，医疗保健沟通技巧的教学主要侧重于面对面交流中技能的培养。即使是经验丰富的临床医生，也没有为 COVID-19 大流行期间由于物理距离要求和探视限制而需要的沟通方式转变做好准备。我们旨在开发和试点一个综合的视频介导的沟通培训计划，并在多个机构环境和医学学科中测试其可行性。
教育团队由普通外科和急诊医学（EM）的临床教育者以及模拟和辅导方面的教员专家组成，创建了干预措施。招募了外科和 EM 实习生以及申请这些专业的高年级医学生参加。提供了三个 90 分钟的课程，重点关注 3 个沟通主题，这些主题变得越来越复杂和具有挑战性：传递坏消息、关怀目标讨论和医疗失误披露。这是一项混合方法研究，使用问卷调查和对开放评论字段的叙述性分析。
学习者的招募因机构而异，但都很成功，大多数（75%）学习者认为这次经历很有价值。所有参与者都表示，他们能够独立或在最小帮助下领导困难的讨论。只有大约一半（52%）的参与者报告在课程结束后有信心独立披露医疗失误。
我们发现该计划在可接受性、需求、实施能力和实用性方面是可行的。在所研究的 3 个沟通主题中，披露医疗失误的信心被证明是最困难的。这些计划的最佳长度和结构需要进一步研究。
