开发一种综合的里程碑评估工具，用于多个早期采用者计划中的打破坏消息：一个试点项目。
Development of an integrated milestone assessment tool across multiple early-adopter programs for breaking bad news: a pilot project.
机构信息
Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA.
出版信息
BMC Med Educ. 2024 Mar 20;24(1):313. doi: 10.1186/s12909-023-04715-1.
BACKGROUND
The transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol.
METHODS
The IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be "easy" and "intermediate" in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cases in sessions held in November 2013 and May 2014. Standardized patients completed an assessment checklist to evaluate each resident's performance in breaking bad news based on their use of the SPIKES protocol and IMA tool. Residents answered post-encounter questions about their training and comfort in breaking bad news. The association between SPIKES and IMA scores was investigated by simple linear regression models and Spearman rank correlations.
RESULTS
There were 136 eligible medical residents: 108 (79.4%) participated in the first session and 97 (71.3%) participated in the second session, with 96 (70.6%) residents participating in both sessions. Overall, we were able to identify residents that performed at both extremes of the assessment criteria using the integrated milestone assessment (IMA) and the SPIKES protocol. Interestingly, residents rated themselves below "comfortable" on average.
CONCLUSION
We developed an integrated milestone assessment (IMA) that was better than the SPIKES protocol at assessing the skill of breaking bad news. This collaborative assessment tool can be used as supplement tool in the era of milestone transformation. We aim assess our tool in other specialties and institutions, as well as assess other shared milestones across specialties.
背景
研究生医学教育认证委员会（ACGME）向里程碑评估的转变为研究生医学课程的合作和共享评估创造了机会。告知坏消息是一种基本的沟通技巧，几乎每个医学专业都有这一共性的里程碑。本研究的目的是开发和试点一个使用 ACGME 里程碑标准的综合里程碑评估（IMA）工具，用于告知坏消息，并将该 IMA 工具与现有的 SPIKES 协议进行比较。
方法
使用专业精神和人际沟通技巧的子锚点创建 IMA 工具，这些子锚点适用于每个专业和告知坏消息的能力。使用两个设计为“简单”和“中等”难度的告知坏消息的案例来评估来自六个住院医师专业的一年级住院医师在告知坏消息方面的基本技能。2013 年 11 月和 2014 年 5 月举行的会议中，对 8 名标准化患者进行了培训，以扮演这些病例。标准化患者完成了一份评估清单，根据他们使用 SPIKES 协议和 IMA 工具的情况，对每位住院医师在告知坏消息方面的表现进行评估。住院医师回答了关于他们在告知坏消息方面的培训和舒适度的后续问题。使用简单线性回归模型和 Spearman 等级相关对 SPIKES 和 IMA 评分之间的关联进行了研究。
结果
共有 136 名符合条件的住院医师：108 名（79.4%）参加了第一次会议，97 名（71.3%）参加了第二次会议，96 名（70.6%）参加了两次会议。总的来说，我们能够使用综合里程碑评估（IMA）和 SPIKES 协议识别出评估标准两端的住院医师。有趣的是，住院医师的平均自我评估低于“舒适”。
结论
我们开发了一种综合里程碑评估（IMA），该评估在评估告知坏消息的技能方面优于 SPIKES 协议。这种协作评估工具可以作为里程碑转变时代的补充工具。我们的目标是在其他专业和机构中评估我们的工具，并评估其他专业共有的里程碑。
Zotero 插件