Hayes John R, Ark Tavinder, Ruffalo Leslie, Mumm Beatrice, Nowik Julia
Medical College of Wisconsin, Department of Community and Family Medicine, Wauwatosa, WI.
Data Sciences Institute, Medical College of Wisconsin, Wauwatosa, WI.
PRiMER. 2025 Jul 15;9:36. doi: 10.22454/PRiMER.2025.631398. eCollection 2025.
Physicians frequently face challenging conversations, yet medical education often inadequately prepares them for discussions on health literacy, behavior change, and end-of-life care. To bridge this gap, the Medical College of Wisconsin created the "Mastering the Difficult Conversations" online elective for senior medical students. This study analyzes the course's effectiveness in enhancing communication skills training.
A 4-week, online elective utilized interactive workshops and formative Objective Structured Clinical Examinations (OSCEs) addressing four themes: overcoming health literacy barriers, managing agitated patients, inspiring behavior change, and delivering bad news. Students engaged in prereading, role play, and reflection. Zoom-based OSCEs with standardized patients and faculty provided immediate feedback. We analyzed qualitative data from 35 reflection papers over 4 years and quantitative standardized assessment data.
Results indicated five primary themes from reflection papers: goals, empathy, lessons learned, identified strengths, and positive remarks. Anonymous evaluations showed high student satisfaction, with the course meeting its objectives of enhancing communication skills and professionalism.
This study confirms that a structured communication program with interactive discussions and formative OSCEs improves medical students' preparedness for difficult patient interactions. The Zoom-based format proved a viable and favorably rated educational tool, replicable across distances. Despite limitations such as sample size and the need for longitudinal data, these findings highlight the importance of expanding structured communication curricula to enhance patient outcomes and physician well-being.
医生经常面临具有挑战性的对话，然而医学教育往往没有充分让他们为关于健康素养、行为改变和临终关怀的讨论做好准备。为了弥合这一差距，威斯康星医学院为高年级医学生开设了“掌握困难对话”在线选修课。本研究分析了该课程在加强沟通技能培训方面的有效性。
一门为期4周的在线选修课利用互动研讨会和形成性客观结构化临床考试（OSCE），涉及四个主题：克服健康素养障碍、管理烦躁不安的患者、激发行为改变以及传达坏消息。学生进行预读、角色扮演和反思。基于Zoom的OSCE与标准化患者和教员一起提供即时反馈。我们分析了4年中35篇反思论文的定性数据以及定量标准化评估数据。
结果表明反思论文有五个主要主题：目标、同理心、经验教训、确定的优势和积极评价。匿名评估显示学生满意度很高，该课程达到了提高沟通技能和专业素养的目标。
本研究证实，一个具有互动讨论和形成性OSCE的结构化沟通项目可以提高医学生应对困难患者互动的准备程度。基于Zoom的形式被证明是一种可行且评价良好的教育工具，可以远程复制。尽管存在样本量和纵向数据需求等局限性，但这些发现凸显了扩大结构化沟通课程以改善患者治疗效果和医生福祉的重要性。
