Gallimore Casey E, Rotzenberg Katherine
University of Wisconsin-Madison, 777 Highland Ave, Madison, WI 53705, United States.
Curr Pharm Teach Learn. 2023 Jan;15(1):91-100. doi: 10.1016/j.cptl.2023.02.013. Epub 2023 Mar 11.
Appropriately engaging with patients around sensitive, challenging, or uncomfortable topics, often termed "difficult conversations," is a facet of patient-centered care. Development of such skills prior to practice often occurs in the hidden curriculum. Instructors implemented and evaluated a longitudinal simulation-based module aimed at advancing students' understanding and abilities to use patient-centered care skills to navigate difficult conversations within the formal curriculum.
The module was embedded within the third professional year of a skills-based laboratory course. Four simulated patient encounters were revised to increase opportunities to practice patient-centered skills during difficult conversations. Preparatory discussions and pre-simulation assignments delivered foundational knowledge, and post-simulation debriefing allowed for feedback and reflection. Students completed pre- and post-simulation surveys to measure understanding of patient-centered care, empathy, and perceived ability. Instructors assessed student performance in eight skill areas using the Patient-Centered Communication Tools.
Of 137 students, 129 completed both surveys. Students' definitions of patient-centered care grew in accuracy and detail following module completion. Eight of the 15 empathy items were significantly changed from pre- to post-module, signifying enhanced empathy. Student perception of ability to perform patient-centered care skills significantly improved from baseline to post-module. Across the semester, student performance on simulations significantly improved on six out of eight patient-centered care skills.
Students deepened their understanding of patient-centered care, grew in aspects of empathy, and improved actual and perceived ability to deliver care that is patient-centered during challenging encounters.
围绕敏感、具有挑战性或令人不适的话题与患者进行恰当沟通，通常被称为“艰难对话”，这是以患者为中心的医疗服务的一个方面。此类技能在实际操作前的培养往往在隐性课程中进行。教师实施并评估了一个基于模拟的纵向模块，旨在提升学生对以患者为中心的医疗服务技能的理解，以及在正式课程中运用这些技能应对艰难对话的能力。
该模块嵌入了一门基于技能的实验室课程的第三专业学年。对四次模拟患者问诊进行了修订，以增加在艰难对话中练习以患者为中心技能的机会。预备讨论和模拟前作业传授基础知识，模拟后汇报则提供反馈和反思机会。学生完成模拟前和模拟后的调查，以衡量对以患者为中心的医疗服务、同理心以及感知能力的理解。教师使用以患者为中心的沟通工具评估学生在八个技能领域的表现。
137名学生中，129名完成了两项调查。模块完成后，学生对以患者为中心的医疗服务的定义在准确性和细节方面都有所提升。15项同理心项目中有8项在模块前后有显著变化，表明同理心增强。学生对执行以患者为中心的医疗服务技能的感知能力从基线到模块后有显著提高。在整个学期中，学生在模拟中的表现有八项以患者为中心的医疗服务技能中的六项有显著提升。
学生加深了对以患者为中心的医疗服务的理解，在同理心方面有所成长，并提高了在具有挑战性的接触中提供以患者为中心的护理的实际和感知能力。
