Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.
Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.
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DOI：
10.1371/journal.pone.0012426
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发表时间：
2010-08-26
期刊：
影响因子：
3.7
通讯作者：
Razavi D
中科院分区：
文献类型：
--
作者：
Liénard A;Merckaert I;Libert Y;Bragard I;Delvaux N;Etienne AM;Marchal S;Meunier J;Reynaert C;Slachmuylder JL;Razavi D
与患者沟通是医学中的核心临床技能，可以通过沟通技能培训获得。与此同时，沟通技能转移到工作场所的重要性尚未得到充分研究。本研究旨在评估一个40小时的培训计划，旨在提高病人的满意度和居民的沟通技巧，在他们的日常临床查房的效果。住院医师被随机分配到培训计划或等待名单。每次访视后使用视觉模拟量表评估患者的满意度。在一个为期半天的临床回合中，通过对实际住院患者的访问录音来评估住院患者的沟通技能。使用内容分析软件（LaComm）分析转录的录音带。训练效果用Mann-Whitney检验和广义线性Poisson回归模型进行检验。88名居民被包括在内。首先，与未经培训的居民（中位数= 88）（p = 0.046）相比，与经过培训的居民互动的患者对居民沟通的满意度更高（中位数= 92）。 第二，受过训练的居民使用更多的评估话语（相对风险（RR）= 1.17; 95%置信区间（95%CI）= 1.02-1.34; p = 0.023）。 第三，当考虑到住院医师的培训出勤率时，也观察到迁移：住院医师使用评估话语（RR = 1.01; 95%CI = 1.01-1.02; p = 0.018）和支持话语（RR = 0.99; 95%CI = 0.98-1.00; p = 0.042）（同理心分别为1.15（RR），1.08-1.23（95%CI），p<0.001;放心分别为0.95（RR），0.92-0.99（95%CI），p = 0.012）与培训出勤的小时数成比例。 培训计划提高了患者的满意度，并使住院医师的沟通技能学习转移到工作场所。调动与参加培训直接相关，但仍然有限。因此，未来的研究应侧重于提高沟通技能培训的有效性，以确保更重要的培训效果的大小迁移。
Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds. Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm). Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models. Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median = 92) compared to patients interacting with untrained residents (Median = 88) (p = .046). Second, trained residents used more assessment utterances (Relative Risk (RR) = 1.17; 95% Confidence intervals (95%CI) = 1.02–1.34; p = .023). Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR = 1.01; 95%CI = 1.01–1.02; p = .018) and supportive utterances (RR = 0.99; 95%CI = 0.98–1.00; p = .042) (respectively 1.15 (RR), 1.08–1.23 (95%CI), p<.001 for empathy and 0.95 (RR), 0.92–0.99 (95%CI), p = .012 for reassurance) was proportional to the number of hours of training attendance. The training program improved patients' satisfaction and allowed the transfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer.
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