An interprofessional training to improve advance care planning skills among medicine, nursing, and social work students.
An interprofessional training to improve advance care planning skills among medicine, nursing, and social work students.
复制标题
DOI：
10.1016/j.xjep.2020.100382
复制
发表时间：
2020-12-01
影响因子：
--
通讯作者：
Cagle, John G
中科院分区：
文献类型：
--
作者：
Millstein, Leah S;Allen, John;Cagle, John G
医疗保健专业学生的次优培训是成功完成患者和家属的预先护理计划（ACP）的公认障碍。我们的研究旨在提高ACP知识和沟通技巧的跨专业医疗保健学生。在2017-2018学年，46名学生（19-医学，16-护理和11-社会工作），接受了由跨专业教师提供的三个培训模块。学生随后观察了一个临床ACP遇到参加了一个病人和他们的家人，一个临床社会工作者，和一个内科住院医生。三项调查（培训前T1，培训后T2和临床后遇到T3）评估学生知识，沟通自我效能，ACP自我效能和跨专业团队合作（使用SPICE-R）的变化。采用随机等待名单方法来检验临床ACP培训的效果。学生的出勤率和参与度都很高。相对于基线，所有数据收集间隔的所有结局均不同（p < 0.05），除了SPICE-R从T2到T3（p > 0.05）。ACP自我效能评分在T2时下降，然后在T3时改善。沟通自我效能在T2时较低，但在T3时有所改善。团队合作得到改善，在T2时具有中等-大效应（ES = 0.75），在T3时具有大效应（ES = 1.00）。参与者对ACP的了解总体上（p < 0.001）以及每个学科（p < 0.05）都有所改善。初步研究结果表明，跨专业的培训经验提高了学生的沟通技巧，ACP知识，并赞赏以团队为基础的护理。T2的研究结果表明，通信和ACP自我效能的下降，也许表明学生最初低估了ACP的复杂性，高估了他们的能力，交流有关ACP。T3研究结果进一步表明，学生最终受益于培训经验，所有关键成果都有了有意义的改善。
Suboptimal training for healthcare students is a recognized barrier to successful completion of advance care planning (ACP) with patients and families. Our study sought to enhance ACP knowledge and communication skills for interprofessional healthcare students. During academic year 2017-2018, 46 students (19-medicine, 16-nursing, and 11-social work), received three training modules delivered by interprofessional faculty. Students subsequently observed a clinical ACP encounter attended by a patient and their family, a clinical social worker, and an internal medicine resident. Three surveys (pre-training T1, post-training T2, and post-clinical encounter T3) evaluated change in student knowledge, communication self-efficacy, ACP self-efficacy, and interprofessional teamwork (using SPICE-R). A randomized waitlist approach was used to test the effects of the clinical ACP training. Student attendance and engagement were high. Relative to baseline, all outcomes differed at all data collection intervals (p < 0.05), except for the SPICE-R from T2 to T3 (p > 0.05). ACP self-efficacy scores declined at T2 before improving at T3. Communication self-efficacy was lower at T2 but improved at T3. Teamwork improved with a medium-large effect (ES = 0.75) at T2 and a large effect (ES = 1.00) at T3. Participant knowledge of ACP improved overall (p < 0.001) as well as for each discipline (p < 0.05). Preliminary findings indicate the interprofessional training experience enhanced student communication skills, ACP knowledge, and appreciation for team-based care. T2 findings demonstrate decrease in communication and ACP self-efficacy, perhaps suggesting students initially underestimated ACP complexity and overestimated their ability to communicate about ACP. T3 findings further suggest that students ultimately benefited from the training experience with meaningful improvements on all key outcomes.