Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Dublin.
Department of Communication, College of Liberal Arts and Sciences, University of Illinois Urbana-Champaign, Champaign.
Hosp Pediatr. 2024 Oct 1;14(10):852-859. doi: 10.1542/hpeds.2024-007777.
Managing uncertainty is a core competency of pediatric residents. However, discussing uncertainty with attending physicians can be challenging. Research is needed to understand residents' goals when communicating about uncertainty with attending physicians and how residents' perceptions of communication change during residency. Therefore, we assessed changes in residents' perceptions of their own ability to communicate uncertainty and their perceptions of attending physicians' willingness to discuss uncertainty effectively. We also identify residents' goals and challenges communicating uncertainty.
We conducted a 3-year (2018-2021) survey with 2 cohorts of residents at a US children's hospital. Of the 106 eligible residents, 100 enrolled and completed Phase I (94% response rate), 61 of the enrolled residents completed Phase II (61% response rate), and 53 completed Phase III (53% response rate). We employed hierarchical linear modeling to account for clustering of the data (Phases within residents) and to assess changes in communication efficacy and target efficacy over time. We coded open-ended responses to identify residents' communication goals and challenges.
Communication efficacy and target efficacy significantly increased over time. Open-ended responses indicated that residents managed multiple task, identity, and relational goals. Residents described persistent challenges related to wanting to appear competent and working with attending physicians who were unwilling to discuss uncertainty.
Although residents may grow more confident communicating uncertainty, such conversations are complex and can present challenges throughout residency. Our results support the value of training on communication about uncertainty, not only for residents, but also attending physicians.
管理不确定性是儿科住院医师的核心能力。然而，与主治医生讨论不确定性可能具有挑战性。需要研究以了解住院医师在与主治医生沟通不确定性时的目标，以及住院医师在住院期间对沟通的看法如何变化。因此，我们评估了住院医师对自己沟通不确定性能力的看法以及对主治医生有效讨论不确定性意愿的看法的变化。我们还确定了住院医师沟通不确定性的目标和挑战。
我们在美国一家儿童医院对 2 个队列的住院医师进行了为期 3 年（2018-2021 年）的调查。在 106 名符合条件的住院医师中，有 100 名参加并完成了第 I 阶段（94%的回复率），参加的 61 名住院医师中有 61%（61%的回复率）完成了第 II 阶段，53 名完成了第 III 阶段（53%的回复率）。我们采用分层线性建模来解释数据的聚类（住院医师内的阶段），并评估沟通效果和目标效果随时间的变化。我们对开放式回答进行编码，以确定住院医师的沟通目标和挑战。
沟通效果和目标效果随时间显著增加。开放式回答表明，住院医师管理着多种任务、身份和关系目标。住院医师描述了与想要表现出能力以及与不愿讨论不确定性的主治医生合作相关的持续挑战。
尽管住院医师在沟通不确定性方面可能会变得更加自信，但此类对话很复杂，并且在整个住院期间可能会带来挑战。我们的研究结果支持对不确定性沟通进行培训的价值，不仅针对住院医师，也针对主治医生。
