传递坏消息：一种医学生主动学习的方法。
Breaking bad news: an active learning method for medical students.
机构信息
Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France.
Department of Obstetrical-Gynecology, Robert-Debré Hospital, AP-HP, Paris Cité University, Paris, EU, France.
出版信息
BMC Med Educ. 2024 Sep 12;24(1):994. doi: 10.1186/s12909-024-05821-4.
BACKGROUND
Breaking bad news is one of the most difficult aspects of communication in medicine. The objective of this study was to assess the relevance of a novel active learning course on breaking bad news for fifth-year students.
METHODS
Students were divided into two groups: Group 1, the intervention group, participated in a multidisciplinary formative discussion workshop on breaking bad news with videos, discussions with a pluri-professional team, and concluding with the development of a guide on good practice in breaking bad news through collective intelligence; Group 2, the control group, received no additional training besides conventional university course. The relevance of discussion-group-based active training was assessed in a summative objective structured clinical examination (OSCE) station particularly through the students' communication skills.
RESULTS
Thirty-one students were included: 17 in Group 1 and 14 in Group 2. The mean (range) score in the OSCE was significantly higher in Group 1 than in Group 2 (10.49 out of 15 (7; 13) vs. 7.80 (4.75; 12.5), respectively; p = 0.0007). The proportion of students assessed by the evaluator to have received additional training in breaking bad news was 88.2% (15 of the 17) in Group 1 and 21.4% (3 of the 14) in Group 2 (p = 0.001). The intergroup differences in the Rosenberg Self-Esteem Scale and Jefferson Scale of Empathy scores were not significant, and both scores were not correlated with the students' self-assessed score for success in the OSCE.
CONCLUSION
Compared to the conventional course, this new active learning method for breaking bad news was associated with a significantly higher score in a summative OSCE. A longer-term validation study is needed to confirm these exploratory data.
背景
传递坏消息是医学沟通中最困难的方面之一。本研究的目的是评估一种新的主动学习课程在传递坏消息方面对五年级学生的相关性。
方法
学生分为两组：第 1 组，干预组，参加了一个关于传递坏消息的多学科形成性讨论研讨会，包括视频、与多专业团队的讨论，最后通过集体智慧制定了一份关于传递坏消息的良好实践指南；第 2 组，对照组，除了常规大学课程外，没有接受额外的培训。通过学生的沟通技巧，在一个总结性的客观结构化临床考试（OSCE）站评估基于讨论组的主动培训的相关性。
结果
共有 31 名学生入组：第 1 组 17 名，第 2 组 14 名。OSCE 中的平均（范围）得分在第 1 组明显高于第 2 组（分别为 15 分（7-13 分）中的 10.49 分和 12.5 分中的 7.80 分；p=0.0007）。评估者评估的接受额外坏消息传递培训的学生比例在第 1 组为 88.2%（17 名中的 15 名），在第 2 组为 21.4%（14 名中的 3 名）（p=0.001）。两组间的 Rosenberg 自尊量表和 Jefferson 同理心量表评分差异无统计学意义，且两组的评分均与学生对 OSCE 成功的自我评估评分无关。
结论
与传统课程相比，这种新的主动学习坏消息传递方法在总结性 OSCE 中得分明显更高。需要进行更长时间的验证研究来确认这些探索性数据。
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