Phillips Mitchell L, Tsao Michelle, Davis-Sandfoss Andrew, Benzon Hubert, Mitchell John D, Barsuk Jeffrey H, Ballard Heather A
The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; , and are Assistant Professors; is a Fellow; and is an Associate Professor. is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL.
J Educ Perioper Med. 2023 Jul 1;25(3):E710. doi: 10.46374/volxxv_issue3_Phillips. eCollection 2023 Jul-Sep.
Breaking bad news (BBN) is an important clinical task for physicians. Unfortunately, there is no standard method to teach and assess these skills of anesthesiologists. Although anesthesiology has become a relatively safe medical specialty, complications still occur that require disclosure to patients and their families. Disclosure of bad news can be a significant source of stress for clinicians, especially for those who have low confidence in their BBN skills. Anesthesiologists' skills in BBN can be improved with simulation-based mastery learning (SBML), an intense form of competency-based learning.
An SBML curriculum was developed using the SPIKES (Situation, Perception, Invitation, Knowledge, Emotion, Summarize) framework for BBN and the NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for expressing empathy. A pretest-posttest study was conducted from March 2020 to June 2022 to evaluate anesthesiologists' performance in BBN. Participants completed a 2-hour curriculum consisting of a pretest, didactic session, deliberate practice with feedback, and a posttest. Anesthesiologists were assessed using a 16-item skills checklist.
Six anesthesiology attendings and 14 anesthesiology fellows were enrolled in the study. Three of 20 participants met the minimum passing score (MPS) at the time of their pretest. All study participants met the MPS on their first posttest ( < .001). The median participant confidence in BBN significantly increased (3 to 4, < .001). Overall course satisfaction in the curriculum was high, with a median score of 5.
Our study demonstrates that a BBN SBML curriculum for anesthesiologists significantly improved communication skills and confidence in a simulated environment. Because only 3 participants met the MPS before training, our results suggest that anesthesiologists could benefit from further education to gain effective communication skills and that SBML training may be effective to achieve this result.
传达坏消息是医生的一项重要临床任务。不幸的是，目前尚无标准方法来教授和评估麻醉医生的这些技能。尽管麻醉学已成为相对安全的医学专业，但仍会出现并发症，需要向患者及其家属披露。对临床医生而言，披露坏消息可能是压力的重要来源，尤其是那些对传达坏消息技能信心不足的医生。基于模拟的掌握学习（SBML）是一种强化的基于能力的学习形式，可提高麻醉医生传达坏消息的技能。
使用用于传达坏消息的SPIKES（情况、认知、邀请、知识、情感、总结）框架和用于表达同理心的NURSE（命名理解、尊重、支持、探索）陈述，开发了一个SBML课程。2020年3月至2022年6月进行了一项前后测试研究，以评估麻醉医生在传达坏消息方面的表现。参与者完成了一个2小时的课程，包括预测试、理论课程、有反馈的刻意练习和后测试。使用一份16项技能清单对麻醉医生进行评估。
本研究招募了6名麻醉主治医生和14名麻醉住院医生。20名参与者中有3名在预测试时达到了最低及格分数（MPS）。所有研究参与者在首次后测试时均达到了MPS（P<0.001）。参与者对传达坏消息的信心中位数显著提高（从3提高到4，P<0.001）。课程的总体满意度较高，中位数为5分。
我们的研究表明，针对麻醉医生的传达坏消息SBML课程显著提高了模拟环境中的沟通技能和信心。由于只有3名参与者在培训前达到了MPS，我们的结果表明，麻醉医生可能会从进一步教育中受益，以获得有效的沟通技能，并且SBML培训可能有效地实现这一结果。
