Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters.
Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters.
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DOI：
10.15766/mep_2374-8265.11298
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发表时间：
2023
影响因子：
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通讯作者：
Denizard-Thompson N
中科院分区：
文献类型：
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作者：
Famouri ML;Hernandez S;Omlor RL;Lane-Brown M;Evans SM;McIntosh D;Denizard-Thompson N
研究表明，认为自己在医学领域代表性不足或女性的医生和医学实习生在与病人接触时遭遇微侵犯的比例更高。我们设计、实施并评估了一个积极的旁观者培训研讨会，重点是使用标准化患者（SP）方法减轻微侵犯。由内科教师和住院总医师领导。参与者包括31名PGY 1分类和初步内科住院医师。他们参与了三个案例模拟，其中包括患者对医疗团队成员的微侵犯。在案例模拟之前，一个简短的演示概述了微侵犯的例子，并回顾了行为反应框架WAKE（与你是谁合作，问问题/直接陈述，让关键人物参与，并使用分散注意力的技巧）。每次遇到情况后，住院医生都向内科教师汇报情况，并讨论与每种情况相关的问题。所有31名居民都参加了研讨会，并在活动前后完成了一项调查，要求他们通过李克特量表对他们对陈述的同意程度进行排名。参与者报告在识别微侵犯（12%报告增加，p = .002），对表现出微侵犯的患者作出反应的能力（23%报告增加，p < .001）和 与团队成员汇报的能力 （20%报告增加，p < .001）方面有统计学意义上的显著改善。SP模拟可以是一个有效的教学模式，微攻击反应策略在病人遭遇。需要进一步的研究来进一步确定讲习班对其他医疗工作人员受训人员的影响以及随着时间的推移技能的保留。
Studies show that physicians and medical trainees who identify as underrepresented in medicine or as women experience higher rates of microaggressions during patient encounters. We designed, implemented, and evaluated an active bystander training workshop focused on mitigating microaggressions using standardized patient (SP) methodology. Internal medicine faculty members and chief residents led the workshop. Participants included 31 PGY 1 categorical and preliminary internal medicine residents. They participated in three case simulations with SPs involving microaggressions from patients toward a member of the health care team. Prior to the case simulations, a brief presentation outlined examples of microaggressions and reviewed the behavioral response framework WAKE (work with who you are, ask questions/make direct statements, involve key people, and employ distraction techniques). After each encounter, residents debriefed with an internal medicine faculty member and discussed questions related to each scenario. All 31 residents participated in the workshop and, before and after the activity, completed a survey that asked them to rank their agreement with statements via a Likert scale. Participants reported statistically significant improvement in recognizing microaggressions (12% reported increase, p = .002), the ability to respond to patients who exhibit microaggressions (23% reported increase, p < .001), and the ability to debrief with team members (20% reported increase, p < .001). SP simulations can be an effective teaching modality for microaggression response strategies during patient encounters. Additional studies are needed to further characterize the workshop's effect on other medical workforce trainees and retention of skills over time.