Kava Bruce R, Andrade Allen D, Marcovich Robert, Idress Thaer, Ruiz Jorge G
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Geriatric Research Education and Clinical Centers, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
Urol Pract. 2017 Jan;4(1):76-84. doi: 10.1016/j.urpr.2016.01.006. Epub 2016 Sep 16.
Proficiency in communication skills is a core competency of residency training. We evaluated the feasibility, acceptability and applicability of a virtual world objective structured clinical examination that enables practice based learning and assessment of resident communication skills.
A virtual clinical encounter situated in 2 practice settings was developed that uses a human avatar physician and a standardized patient. Following an online tutorial house staff participated in 4 communication tasks, including shared decision making, delivering bad news, obtaining informed consent and disclosing a medical error. Validated instruments and semistructured interviews were used to assess house staff acceptability and applicability of the platform. Three faculty members used ACS (Affective Competency Scale) and communication specific assessment instruments to evaluate house staff performance.
A total of 12 urology house staff completed the simulation. Direct costs were approximately $1,000. The virtual world was easy to use and immersive. Applicability directly correlated with presence (Pearson r = 0.67, p = 0.01) and co-presence (Pearson r = 0.8, p = 0.002). House staff identified problems with 1) limited nonverbal cues, 2) too much information presented and 3) a lack of immediate feedback. The ICC (intraclass correlation) of faculty assessments was high for ACS at 0.53 (95% CI 0.36-0.69) for single measures, 0.77 (95% CI 0.63-0.86) for average measures and less for other assessment instruments.
A virtual world objective structured clinical examination is a feasible, acceptable and applicable method of communication skills assessment. Improving nonverbal cues, focusing on individual skill sets and providing immediate feedback are measures to be adopted in future iterations of this platform.
沟通技能的熟练掌握是住院医师培训的核心能力。我们评估了一个虚拟世界客观结构化临床考试的可行性、可接受性和适用性，该考试能够实现基于实践的学习并评估住院医师的沟通技能。
开发了一个位于两种实践环境中的虚拟临床问诊，使用人类化身医生和标准化患者。在在线教程之后，住院医师参与了4项沟通任务，包括共同决策、传递坏消息、获得知情同意和披露医疗差错。使用经过验证的工具和半结构化访谈来评估住院医师对该平台的可接受性和适用性。三名教员使用情感能力量表（ACS）和特定于沟通的评估工具来评估住院医师的表现。
共有12名泌尿外科住院医师完成了模拟。直接成本约为1000美元。虚拟世界易于使用且具有沉浸感。适用性与临场感直接相关（皮尔逊r = 0.67，p = 0.01）和共同临场感（皮尔逊r = 0.8，p = 0.002）。住院医师指出了以下问题：1）非语言线索有限；2）呈现的信息过多；3）缺乏即时反馈。教员评估的组内相关系数（ICC）对于ACS单一测量为0.53（95%置信区间0.36 - 0.69），平均测量为0.77（95%置信区间0.63 - 0.86），其他评估工具的系数较低。
虚拟世界客观结构化临床考试是一种可行、可接受且适用的沟通技能评估方法。改善非语言线索、关注个体技能集并提供即时反馈是该平台未来迭代中应采取的措施。
