de Meijer F O, Nyamu N, de Bruin A B H
Department of Postgraduate Medical Education, Aga Khan University, Nairobi, Kenya.
School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
Adv Health Sci Educ Theory Pract. 2025 Apr;30(2):515-531. doi: 10.1007/s10459-024-10364-w. Epub 2024 Sep 5.
In healthcare, effective communication in complex situations such as end of life conversations is critical for delivering high quality care. Whether residents learn from communication training with actors depends on whether they are able to select appropriate information or 'predictive cues' from that learning situation that accurately reflect their or their peers' performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predictive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties were randomly assigned to one of two experimental groups during a mock OSCE assessing advanced communication skills. Residents in the intervention arm received paper predictive cue prompts while residents in the control arm received paper regular prompts for self-judgement. In a pre- and post- test, residents' use of predictive cues and the appropriateness of peer-judgements were evaluated against a pre-rated video of another resident. The intervention improved both the use of predictive cues in self-judgement and peer-judgement. Ensuing accuracy of peer-judgements in the pre- to post-test only partly improved: no effect from the intervention was found on overall appropriateness of judgements. However, when analyzing participants' completeness of judgements over the various themes within the consultation, a reduction in inappropriate judgments scores was seen in the intervention group. In conclusion, predictive cue prompts can help learners to concentrate on relevant cues when evaluating communication skills and partly improve monitoring accuracy. Future research should focus on offering prompts more frequently to evaluate whether this increases the effect on monitoring accuracy in communication skills.
在医疗保健领域，在诸如临终谈话等复杂情况下进行有效的沟通对于提供高质量护理至关重要。住院医师能否从与演员的沟通培训中学到东西，取决于他们是否能够从学习情境中选择合适的信息或“预测线索”，这些线索能准确反映他们自己或同行的表现，以及他们是否将这些线索用于后续判断。本研究旨在探讨提示是否有助于医学住院医师更好地利用预测线索并提高沟通技能判断能力。在一项评估高级沟通技能的模拟客观结构化临床考试（OSCE）中，来自8个不同专业的肯尼亚一年级和三年级住院医师（N = 41）被随机分配到两个实验组之一。干预组的住院医师收到纸质预测线索提示，而对照组的住院医师收到纸质常规自我判断提示。在一项前测和后测中，根据另一名住院医师预先评级的视频，评估住院医师对预测线索的使用情况以及同伴判断的适当性。干预提高了自我判断和同伴判断中预测线索的使用。前测到后测中同伴判断的准确性仅部分提高：未发现干预对判断的总体适当性有影响。然而，在分析参与者对会诊中各个主题的判断完整性时，干预组的不适当判断分数有所降低。总之，预测线索提示可以帮助学习者在评估沟通技能时专注于相关线索，并部分提高监测准确性。未来的研究应侧重于更频繁地提供提示，以评估这是否会增加对沟通技能监测准确性的影响。
