Watson Maura A, Howle Anna M, Lenz Oliver, Scalese Ross J, King Joshua D, Bolanos Jonathan A, Yuan Christina M
Walter Reed National Military Medical Center, Bethesda, MD, USA.
University of Miami, FL, USA.
Can J Kidney Health Dis. 2023 Jan 18;10:20543581221150553. doi: 10.1177/20543581221150553. eCollection 2023.
We previously described a nephrology-specific "Breaking Bad News" Objective Structured Clinical Examination (OSCE) assessing nephrology fellow communication and counseling skills in 3 scenarios: kidney replacement therapy (KRT) in kidney failure, urgent KRT in acute kidney injury (AKI), and kidney biopsy (KBx).
The main objectives of this study is to adapt the OSCE to a virtual platform, simulating nephrology patient telemedicine encounters involving difficult conversations, and to assess fellow and faculty satisfaction with the virtual format.
Description of a formative telemedicine simulation for nephrology fellows.
Fully virtual simulation conducted by 2 academic medical simulation centers.
Nephrology faculty and fellows at 3 urban/suburban training programs in the eastern United States.
Description of the virtual OSCE process. Fellow and faculty satisfaction overall and for each scenario. Faculty and fellow estimates of frequency of virtual patient encounters in the past year.
The OSCE consisted of 3 scenarios: KRT in kidney failure, urgent KRT in AKI, and KBx. Objective Structured Clinical Examinations were administered in May 2021. Each scenario lasted 20 minutes. The AKI scenario was audio only. Fellows telephoned a simulated patient surrogate for urgent KRT consent. Kidney failure and KBx scenarios were video encounters. Faculty observed while muted/video off. Immediately after the OSCE, fellows and faculty were anonymously surveyed regarding their satisfaction with each scenario, the OSCE overall, and their estimate of outpatient encounters and inpatient KRT counseling done virtually in the preceding year.
Seventeen fellows completed the OSCE at 2 centers (3 programs). Sixteen (94%) completed the survey. Almost 94% rated the OSCE as a good/very good approximation of telemedicine encounters. Those satisfied/very satisfied with each scenario are as follow: 100% for AKI, 75% for kidney failure, and 75% for KBx. Two commented that they often did urgent KRT counseling by telephone. Fellows estimated a median 20% (interquartile range: 175, 50%) of counseling for acute inpatient KRT and a median 50% (IQR: 33.75, 70%) of outpatient encounters were virtual in the prior year. Two (regarding the kidney failure and KBx scenarios) indicated they would not have counseled similar outpatients virtually.
The 15-minute interactions may be too short to allow the encounter to be completed comfortably. A small number of programs and fellows participated, and programs were located in urban/suburban areas on the east coast of the United States.
Overall, fellows felt that the OSCE was a good approximation of virtual encounters. The OSCE is an opportunity for fellows to practice telemedicine communication skills.
我们之前描述了一种针对肾脏病学的“告知坏消息”客观结构化临床考试（OSCE），该考试在三种场景下评估肾脏病学专科住院医师的沟通和咨询技巧：肾衰竭中的肾脏替代治疗（KRT）、急性肾损伤（AKI）中的紧急KRT以及肾活检（KBx）。
本研究的主要目的是将OSCE改编为虚拟平台，模拟涉及困难对话的肾脏病学患者远程医疗会诊，并评估专科住院医师和教员对虚拟形式的满意度。
对肾脏病学专科住院医师进行的形成性远程医疗模拟描述。
由两个学术医学模拟中心进行的全虚拟模拟。
美国东部3个城市/郊区培训项目的肾脏病学教员和专科住院医师。
虚拟OSCE过程的描述。专科住院医师和教员对整体及每个场景的满意度。教员和专科住院医师对过去一年虚拟患者会诊频率的估计。
OSCE包括三种场景：肾衰竭中的KRT、AKI中的紧急KRT以及KBx。2021年5月进行了客观结构化临床考试。每个场景持续20分钟。AKI场景仅为音频。专科住院医师打电话给模拟患者代理人以获取紧急KRT同意。肾衰竭和KBx场景为视频会诊。教员在静音/关闭视频的状态下观察。OSCE结束后，立即对专科住院医师和教员进行匿名调查，询问他们对每个场景、整体OSCE的满意度，以及他们对前一年虚拟进行的门诊会诊和住院KRT咨询的估计。
17名专科住院医师在两个中心（3个项目）完成了OSCE。16人（94%）完成了调查。近94%的人将OSCE评为远程医疗会诊的良好/非常好的近似模拟。对每个场景满意/非常满意的比例如下：AKI为100%，肾衰竭为75%，KBx为75%。两人表示他们经常通过电话进行紧急KRT咨询。专科住院医师估计，前一年急性住院KRT咨询的中位数为20%（四分位间距：17.5，50%），门诊会诊的中位数为50%（IQR：33.75，70%）是虚拟进行的。两人（针对肾衰竭和KBx场景）表示他们不会对类似的门诊患者进行虚拟咨询。
15分钟的互动可能太短，无法让会诊舒适地完成。参与的项目和专科住院医师数量较少，且项目位于美国东海岸的城市/郊区。
总体而言，专科住院医师认为OSCE很好地近似模拟了虚拟会诊。OSCE是专科住院医师练习远程医疗沟通技巧的一个机会。
