Duval Margaret, Zewdie Monica, Kapadia Muneera R, Liu Chang, Mohess Denise, Bachman Sharon L, Dort Jonathan, Newcomb Anna B
George Washington University School of Medicine and Health Sciences, Washington, D.C. 20007 USA.
University of Virginia School of Medicine, Charlottesville, VA USA.
Global Surg Educ. 2023;2(1):1. doi: 10.1007/s44186-022-00075-4. Epub 2022 Dec 3.
Uncertainty, or the conscious awareness of having doubts, is pervasive in medicine, from differential diagnoses and the sensitivity of diagnostic tests, to the absence of a single known recovery path. While openness about uncertainty is necessary for shared decision-making and is a pillar of patient-centered care, it is a challenge to do so while preserving patient confidence. The authors' aim was to develop, pilot, and evaluate an uncertainty communication curriculum to prepare medical students and residents to confidently navigate such conversations.
The authors developed ADAPT a mnemonic framework to improve student comprehension and recall of the important steps in uncertainty disclosure: assess the patient's knowledge, disclose uncertainty directly, acknowledge patient emotions, plan next steps, and temper expectations. Using this framework, the authors developed, piloted, and evaluated an uncertainty communications course as part of an ongoing communication curriculum for second year medical students in 2020 and with surgical residents in 2021.
Learner confidence in uncertainty communication skills significantly increased post-class. Resident confidence in disclosing uncertainty was significantly correlated with observer ratings of their related communication skills during simulation. Students expressed positive experiences of the class, noting particular appreciation for the outline of steps included in the ADAPT framework, and the ability to observe a demonstration prior to practice.
The ADAPT communication curriculum was effective at increasing learner confidence and performance in communicating uncertainty. More rigorous evaluation of the ADAPT protocol will be important in confirming its generalizability.
The online version contains supplementary material available at 10.1007/s44186-022-00075-4.
不确定性，即对存在疑虑的自觉意识，在医学中普遍存在，从鉴别诊断、诊断测试的敏感性，到不存在单一已知的康复路径。虽然对不确定性保持开放态度对于共同决策是必要的，并且是以患者为中心的医疗的支柱，但在保持患者信心的同时做到这一点是一项挑战。作者的目标是开发、试点并评估一门不确定性沟通课程，以使医学生和住院医师有信心应对此类对话。
作者开发了ADAPT一个助记框架，以提高学生对不确定性披露重要步骤的理解和记忆：评估患者的知识、直接披露不确定性、承认患者的情绪、规划下一步以及调整期望。利用这个框架，作者在2020年为二年级医学生以及在2021年为外科住院医师开发、试点并评估了一门不确定性沟通课程，作为正在进行的沟通课程的一部分。
课后学习者在不确定性沟通技能方面的信心显著提高。住院医师在披露不确定性方面的信心与模拟期间观察者对其相关沟通技能的评分显著相关。学生们对该课程表达了积极的体验，特别赞赏ADAPT框架中包含的步骤概述，以及在实践前能够观看示范。
ADAPT沟通课程在提高学习者在沟通不确定性方面的信心和表现方面是有效的。对ADAPT协议进行更严格的评估对于确认其通用性很重要。
在线版本包含可在10.1007/s44186-022-00075-4获取的补充材料。
