Perkins J J, Sanson-Fisher R W, Anseline P, Gillespie W J, Lowe A
NSW Cancer Council, Cancer Education Research Program, Newcastle, Australia.
Aust N Z J Surg. 1998 Sep;68(9):670-4. doi: 10.1111/j.1445-2197.1998.tb04842.x.
The interactional skills of 21 surgical trainees were studied in the areas of breaking bad news to patients and preparing patients for potentially threatening medical procedures. When compared to the established guidelines for dealing with these issues, the trainees performed poorly.
Trainees were videotaped using clinical histories delivered by simulated patients in simulated consulting rooms. All videos were scored on standard rating scales where the criteria for rating the specific interactional skills were adopted from existing guidelines.
The proportion of trainees who could meet the guidelines when breaking bad news was low. The proportion of trainees who met the guidelines were: closing the the consultation (0%), provided patient information about prognosis (43%) and treatment (38%) and when they gave support (10%). There were also low numbers of trainees who could meet the guidelines when they prepared patients for potentially threatening procedures. Ten per cent of trainees followed the guidelines when providing information, 25% could establish treatment goals, 35% could give a prognosis and 0% could deal appropriately with psychosocial issues or close the consultation appropriately.
It is concluded that there is a need for further formal training in interactional skills as part of surgical training.
对21名外科实习医生在向患者传达坏消息以及让患者为潜在的威胁性医疗程序做准备方面的沟通技巧进行了研究。与处理这些问题的既定指南相比，实习医生的表现不佳。
在模拟诊室中，使用模拟患者提供的临床病史对实习医生进行录像。所有视频均按照标准评分量表进行评分，其中对特定沟通技巧的评分标准采用了现有指南。
在传达坏消息时能够符合指南的实习医生比例较低。符合指南的实习医生比例如下：结束会诊（0%）、提供患者预后信息（43%）和治疗信息（38%）以及给予支持（10%）。在让患者为潜在的威胁性程序做准备时，能够符合指南的实习医生数量也较少。10%的实习医生在提供信息时遵循了指南，25%能够确立治疗目标，35%能够给出预后，0%能够妥善处理心理社会问题或适当地结束会诊。
得出结论，作为外科培训的一部分，需要在沟通技巧方面进行进一步的正规培训。
