Budesa Zach, Klar Melinda, Datta Sujata, Moore Emily, Lamsen Leonard
Center for Advanced Medical Simulation, Graduate School of Medicine, University of Tennessee, Knoxville, Knoxville, Tennessee.
Department of Anaesthesia, University of Maryland Medical Center, Baltimore, Maryland, United States.
J Commun Healthc. 2023 Mar;16(1):30-37. doi: 10.1080/17538068.2022.2026054. Epub 2022 Feb 1.
High quality communication skills are necessary for competent and ethical practice. When patients present with low health literacy, physicians' skills may be lacking, which can put patients' safety and satisfaction at risk. The authors' developed and executed a simulation-based needs assessment following conflicting internal reports about the communications skills of new residents.
The current study recruited first year residents ( = 30) during the 2019 first post-graduate year (PGY-1) orientation at a southeastern university hospital simulation center. The residents completed an Objective Structured Clinical Examination (OSCE) which focused on obtaining informed consent from a patient's health care proxy who presented with limited literacy and health literacy and poor communication skills. After completing the OSCE, the residents, simulated patients (SP), and independent observers assessed the residents' performance.
Residents assessed their performance higher when compared with the ratings from independent observers and patient raters. Residents who spent more time with SPs were given higher ratings by the SPs and independent observers. Finally, residents' ratings of themselves had a positive correlation with their reported confidence, but no correlation between self-confidence and the ratings provided by SPs or observers.
PGY-1 residents demonstrate a continued need for health literacy and informed consent education, despite faculty believing that these skills were covered enough in medical school. These residents also demonstrated limited self-assessment ability or skills below the expectations of health literacy experts. Curriculum changes included improving the focus on health literacy, communication skills, and additional practice opportunities throughout their internship year.
高质量的沟通技巧是胜任工作和符合职业道德规范的必要条件。当患者健康素养较低时，医生的沟通技巧可能会有所欠缺，这会危及患者的安全和满意度。在收到关于新住院医师沟通技巧的相互矛盾的内部报告后，作者开展并实施了一项基于模拟的需求评估。
本研究在东南部一所大学医院模拟中心对2019年第一年住院医师培训（PGY-1）迎新期间的一年级住院医师（n = 30）进行了招募。住院医师完成了一项客观结构化临床考试（OSCE），该考试重点是从一名健康素养有限、沟通技巧较差的患者医疗代理人那里获得知情同意。完成OSCE后，住院医师、模拟患者（SP）和独立观察员对住院医师的表现进行了评估。
与独立观察员和患者评分相比，住院医师对自己表现的评估更高。与模拟患者相处时间更长的住院医师，模拟患者和独立观察员给予他们的评分更高。最后，住院医师对自己的评分与他们报告的自信心呈正相关，但自信心与模拟患者或观察员给出的评分之间没有相关性。
尽管教员认为这些技能在医学院已经得到了充分涵盖，但PGY-1住院医师仍表现出对健康素养和知情同意教育的持续需求。这些住院医师还表现出自我评估能力有限，或技能低于健康素养专家的期望。课程改革包括在整个实习年度加强对健康素养、沟通技巧的关注，并增加实践机会。
