Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

医疗保健服务和结果的差异部分与医生在医疗保健方面的困难有关。 与在种族、民族和性别方面与自己不同的患者建立有效的沟通， 经济情况。糖尿病和糖尿病前期营养性肥胖是一个重要的案例， 点种族和社会经济差异会阻碍医生理解病人的能力。 限制现实，例如日常活动中涉及的复杂权衡和决策策略， 购买食品和药品。当临床遇到糖尿病诊断和管理不 根据病人的实际情况，他们变得不太可能导致对什么是共同的理解。 必须完成这反过来又会导致医生认为少数民族患者不依从， 无视他们的建议。为了有效，这些以医生为基础的关于护理、行为和自我护理的讨论 需要一个适应文化假设、认知/情感问题和系统性社会问题的对话。 患者个人的经济限制。这一领域需要改进-临床医生治疗 受健康差距影响的人口必须具备了解如何制定和 根据这些病人的独特需求来定制他们的对话。我们设想的系统--实现增强型患者 通过援助和培训（重复）的遭遇-将提供一个创新的替代目前（非常 最低限度）训练。它将最佳实践封装在一个低成本、无处不在的可访问系统中， 体验式学习REPEAT将提供一个真实的虚拟环境，允许学习通过 与合成标准化患者（SSP）的模拟互动。这些是交互式的计算机生成的 可以对临床医生（口头和通过非口头）行为做出实际行动和反应的化身。新兴认知 仿真技术将向SSP灌输属性（例如，环境和经济限制， 信念、态度、恐惧），代表特定患者亚群的共有特征。 第一阶段将建立一个初步的REPEAT原型，作为与SSP进行有限的虚拟临床接触 由智能辅导技术中的学习支架支持。这些虚拟的遭遇将 允许临床医生练习与SSP的交互，并从与SSP的交互中学习，SSP代表初始的 关注人群-经济不景气城市的糖尿病前期和糖尿病非裔美国人患者 食物沙漠我们将评估第一阶段原型的学习效果和用户接受度 合作伙伴，弗吉尼亚联邦大学医学院，使用临床医生的样本（n=20）。这 这项工作将为如何开发有效的SSP并将其嵌入可行的 训练环境。这项技术有可能被广泛使用，包括一个版本， 患者可用，并通过改善提供者之间的沟通来减少医疗保健差异， 患者它还专门针对医学生，居民和 文化敏感性和人际交往技能和沟通方面的医生。

Disparities in healthcare delivery and outcomes have been linked, in part, to the difficulties physicians have in establishing effective communication with patients who differ from themselves in terms of race, ethnicity and economic circumstances. Diabetes mellitus and pre-diabetic nutrition-based obesity are an important case in point. Racial and socio-economic differences can impede doctors' ability to understand their patients' constraining realities, such as the complex tradeoffs and decision strategies involved in daily activities like purchasing food and medications. When clinical encounters about diabetes diagnosis and management are not tailored to the patient's pragmatic realities, they become less likely to lead to a shared understanding of what needs to be done. This can, in turn, lead physicians to perceive that minority patients are non-compliant and ignoring their advice. To be effective, these encounter-based discussions about care, behavior, and self-care require a dialog that is adaptive to the cultural assumptions, cognitive/emotional concerns, and systemic socio- economic constraints of the individual patient. This area is in need of improvement - clinicians treating populations affected by health disparities must possess the competencies to understand how to frame and tailor their dialogs to the unique needs of these patients. The system we envision-Realizing Enhanced Patient Encounters through Aiding and Training (REPEAT) - will provide an innovative alternative to current (very minimal) training. It encapsulates best practices in a low cost, ubiquitously accessible system based on experiential learning. REPEAT will offer a realistic virtual environment that allows learning to occur through simulated interactions with synthetic standardized patients (SSPs). These are interactive computer-generated avatars that can act and react realistically to clinician (verbal and via nonverbal) behaviors. Emerging cognitive simulation technology will imbue the SSPs with attributes (e.g., environmental and economic limitations, beliefs, attitudes, fears) that are representative of shared characteristics of a specific patient subpopulation. Phase I will build a preliminary REPEAT prototype as a limited set of virtual clinical encounters with SSPs supported by learning scaffolding drawn from intelligent tutoring technology. These virtual encounters will allow clinicians to practice interacting with, and to learn from interactions with, SSPs that represent an initial population of concern - pre-diabetic and diabetic African-American patients in economically depressed urban food deserts. This Phase I prototype will be assessed for learning effect and user acceptance at our healthcare partner, the Virginia Commonwealth University School of Medicine, using a sample of clinicians (n=20). This work will provide considerable insight into how to develop effective SSPs and embed them into a viable training environment. The technology has the potential to be translated to broad usage, including a version usable by patients, and to reduce healthcare disparities by improving communication among providers and patients. It also specifically addresses broader mandated requirements for medical students, residents and physicians in Cultural sensitivity, and Interpersonal Skills and Communication.