与围产期咨询沟通不确定性:产科实习生多模式课程的随机对照试验

Melissa Spiel DO , Eve M. Roth MD , Allison A. Merz-Herrala MD , Anna Modest PhD, MPH , Brett C. Young MD
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引用次数: 0

摘要

对不确定的预后进行有效的沟通是产科的一项关键技能。然而,很少有课程能让医学教育的毕业生为这些高风险的对话做好准备。目的设计并评价一套多模式课程,以提高产科实习生在传达不确定预后时的沟通技巧。方法:在这项盲法、随机对照试验中,某学术医疗中心的产科住院医师被分配到标准教学组或接受结构化、多模式课程的干预组。干预包括阅读SPIKES协议和医生移情,教学视频和促进小组讨论。干预后两周,所有参与者都参加了一个标准化的患者会议,模拟早产产前胎膜破裂的可存活诊断。沟通表现是用一个结构化的标准来评估的,以及交流前后的压力水平。结果23名产科实习生完成了研究。干预组的沟通得分显著高于对照组(平均19.5分vs 15.5分;P=.02),更多地使用以病人为中心的技术,如承认焦虑和尽量减少术语。在模拟过程中,他们也报告了较低的压力水平(5分制的平均3.2 vs 4.0, P= 0.003)。干预后的调查显示,在提供复杂的预后和对情绪暗示做出反应方面,患者的舒适度有所提高。结论:这种结构化的基于spike的课程显著提高了产科学员在涉及不确定预后的模拟咨询场景中的沟通表现和信心。课程是可行的整合到研究生医学教育,并与ACGME沟通能力一致。这些发现支持在产科更广泛地实施结构化沟通培训,以提高学习者的学习效果和以患者为中心的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Communicating uncertainty with perinatal counseling: a randomized controlled trial of a multimodal curriculum for obstetrical trainees

Background

Effective communication of uncertain prognoses is a critical skill in obstetrics. Yet few curricula exist to prepare graduate medical education trainees for these high-stakes conversations.

Objective

To design and evaluate a multimodal curriculum for improving obstetric trainees' communication skills when conveying uncertain prognoses.

Methods

In this blinded, randomized controlled trial, obstetrics residents at an academic medical center were assigned to either a standard didactic session or an intervention group receiving a structured, multimodal curriculum. The intervention included a reading assignment on the SPIKES protocol and physician empathy, an instructional video, and facilitated small-group discussion. Two weeks post-intervention, all participants engaged in a standardized patient encounter simulating a periviable diagnosis of preterm prelabor rupture of membranes. Communication performance was assessed using a structured rubric, and stress levels before and after the encounter.

Results

Twenty-three obstetric trainees completed the study. The intervention group demonstrated significantly higher communication scores (mean score 19.5 vs 15.5; P=.02) and greater use of patient-centered techniques such as acknowledging anxiety and minimizing jargon. They also reported lower stress levels during the simulation (mean 3.2 vs 4.0 on a 5-point scale, P=.003). Post-intervention surveys revealed improved comfort with delivering complex prognoses and responding to emotional cues.

Conclusion

This structured SPIKES-based curriculum significantly enhanced obstetric trainees’ communication performance and confidence in simulated counseling scenarios involving uncertain prognoses. The curriculum is feasible for integration into graduate medical education and aligns with ACGME communication competencies. These findings support broader implementation of structured communication training in obstetrics to improve both learner outcomes and patient-centered care.
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来源期刊
AJOG global reports
AJOG global reports Endocrinology, Diabetes and Metabolism, Obstetrics, Gynecology and Women's Health, Perinatology, Pediatrics and Child Health, Urology
CiteScore
1.20
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