Ho Cindy, Weisleder Pedro, Ream Margie A, Albert Dara V F
From the Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University, Columbus.
Neurol Educ. 2025 Feb 10;4(1):e200187. doi: 10.1212/NE9.0000000000200187. eCollection 2025 Mar.
Child neurology is a specialty with unique challenges in communication. Child neurologists face many complex disorders with a wide array of prognoses and treatments as well as the need to communicate at various developmental levels. Limited literature exists regarding effective communication training during child neurology residency. Our aim was to evaluate feedback provided to child neurology residents by standardized patients (SPs) and faculty during a communication-focused objective structured clinical examination (OSCE) for common themes and identify which elements of communication feedback are most valuable to the residents.
The child neurology residency at Nationwide Children's Hospital previously developed a set of OSCE cases to assess residents' communication skills. Using a qualitative approach, we used content analysis to identify themes from the feedback residents received from SPs and faculty observers. After themes were identified, we held a focus group with residents to determine which themes contained helpful feedback.
Residents found feedback from both SPs and faculty observers to be important, and how information was delivered was identified as the most impactful type of feedback. Residents appreciated positive feedback from SPs and faculty, especially when aimed at reinforcing a specific behavior that was performed well. Feedback that residents identified as particularly helpful, although not commonly provided, was the recognition of a potential unconscious bias in an encounter. Feedback the residents found less useful was discussing the medical specifics of the case. The most frequently provided types of feedback were not necessarily the most helpful feedback for both SP and faculty feedback.
OSCEs can be an effective tool to provide child neurology residents with immediate feedback on their communication skills with difficult conversations in a safe environment. Residents find value in feedback from both the SPs and faculty observers. Certain elements of feedback are more helpful than others. This knowledge could be used to develop an assessment tool to guide feedback from child neurology-specific communication simulation.
儿童神经病学是一个在沟通方面面临独特挑战的专业领域。儿童神经科医生面对许多复杂疾病，这些疾病有着广泛的预后情况和治疗方法，同时还需要在不同发育水平上进行沟通。关于儿童神经病学住院医师培训期间有效沟通训练的文献有限。我们的目的是评估在以沟通为重点的客观结构化临床考试（OSCE）期间标准化病人（SP）和教员向儿童神经病学住院医师提供的反馈，以确定共同主题，并找出对住院医师最有价值的沟通反馈要素。
全国儿童医院的儿童神经病学住院医师培训项目此前开发了一套OSCE病例，以评估住院医师的沟通技巧。我们采用定性方法，通过内容分析从住院医师收到的来自SP和教员观察员的反馈中识别主题。确定主题后，我们与住院医师举行了焦点小组讨论，以确定哪些主题包含有用的反馈。
住院医师发现来自SP和教员观察员的反馈都很重要，信息传递方式被确定为最具影响力的反馈类型。住院医师感谢来自SP和教员的积极反馈，尤其是当这种反馈旨在强化某种表现出色的特定行为时。住院医师认为特别有帮助但不常提供的反馈是对诊疗过程中潜在无意识偏见的认识。住院医师认为不太有用的反馈是讨论病例的医学细节。对于SP和教员的反馈来说，最常提供的反馈类型不一定是最有帮助的反馈。
OSCE可以成为一种有效的工具，在安全的环境中就困难对话向儿童神经病学住院医师提供关于其沟通技巧的即时反馈。住院医师发现来自SP和教员观察员的反馈都有价值。某些反馈要素比其他要素更有帮助。这些知识可用于开发一种评估工具，以指导来自儿童神经病学特定沟通模拟的反馈。
