Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News
Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News
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DOI：
10.1016/j.jpainsymman.2018.11.012
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发表时间：
2019-03-01
影响因子：
4.7
通讯作者：
Wayne, Diane B.
中科院分区：
文献类型：
--
作者：
Vermylen, Julia H.;Wood, Gordon J.;Wayne, Diane B.
导言。医生沟通会影响患者的预后。然而，沟通技巧，特别是在困难的对话中，仍然不是最好的，而且没有明确的方法来确定委托决定的有效性。这项研究的目的是1)描述基于模拟的掌握学习(SBML)课程的开发，用于突发坏消息(BBN)会话技能；2)设定可防御的最低通过标准(MPS)，以确保学习者获得统一的技能。为四年级医学生开发了SBML BBN课程。创建了一种评估工具，以评估BBN对话中涉及的技能的获得情况。完成了初步测试，以确认技能获得的改进并设置MPS。结果。开发了BBN评估工具，其中包括15个项目清单和6个比例尺项目。学生的检查表成绩在测试后较基线显著提高(平均65.33%，SD12.09%vs平均88.67%，SD9.45%，P<；0.001)。学生在考试后的六个问题上至少得4分(满分为5分)的可能性也明显更大。MPS设置为80%，要求核对表上的12个项目得分，每个量表项目至少得4分(满分5分)。使用MPS，30%的学生需要在后测试后进行额外培训。我们开发了SBML课程，对BBN技能进行全面评估，并制定了可辩护的能力标准。未来的努力将把掌握模式扩展到更大的队列，并评估严格教育对患者护理结果的影响。(C)2018年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Introduction. Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation. An SBML BBN curriculum was developed for fourth yearmedical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes. A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD 12.09% vs mean 88.67%, SD 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments. We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.