Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany.
Technische Universität München, Fakultät für Medizin, TUM Medical Education Center, München, Germany.
GMS J Med Educ. 2023 Feb 15;40(1):Doc7. doi: 10.3205/zma001589. eCollection 2023.
Dealing with medical uncertainty is an essential competence of physicians. During handovers, communication of uncertainty is important for patient safety, but is often not explicitly expressed and can hamper medical decisions. This study examines medical students' implicit expression of uncertainty in different sequences of clinical reasoning during simulated patient handovers.
In 2018, eighty-seven final-year medical students participated in handovers of three simulated patient cases, which were videotaped and transcribed verbatim. Sequences of clinical reasoning and language references to implicit uncertainty that attenuate and strengthen information based on a framework were identified, categorized, and analyzed with chi-square goodness-of-fit tests.
A total of 6358 sequences of clinical reasoning were associated with the four main categories , and , with statements occurring significantly (p<0.001) most frequently. Attenuated sequences of clinical reasoning occurred significantly (p<0.003) more frequently than strengthened sequences. Implications were significantly more often attenuated than strengthened (p<0.003). Statements regarding results occurred significantly more often plain or strengthened than statements regarding actions (p<0.0025).
Implicit expressions of uncertainty in simulated medical students' handovers occur in different degrees during clinical reasoning. These findings could contribute to courses on clinical case presentations by including linguistic terms and implicit expressions of uncertainty and making them explicit.
应对医学不确定性是医生的一项基本能力。在交接班过程中，不确定性的沟通对于患者安全很重要，但通常没有明确表达，并且可能会妨碍医疗决策。本研究考察了医学生在模拟患者交接班过程中不同临床推理序列中隐含表达不确定性的情况。
2018 年，87 名即将毕业的医学生参与了三个模拟患者病例的交接班，这些病例被录像并逐字记录下来。根据一个框架，确定了临床推理序列和语言参考，以衰减和强化基于信息的不确定性，并使用卡方拟合优度检验对其进行分类和分析。
共 6358 个临床推理序列与四个主要类别相关，并且陈述出现的频率显著（p<0.001）。衰减的临床推理序列比强化的序列更频繁地出现（p<0.003）。暗示比强化更频繁地被衰减（p<0.003）。与关于行动的陈述相比，关于结果的陈述更频繁地被简单或强化地表达（p<0.0025）。
在模拟医学生交接班过程中，临床推理中隐含表达的不确定性程度不同。这些发现可以通过在临床病例呈现课程中包含语言术语和隐含的不确定性表达，并使其变得明确，从而为其做出贡献。
