Promoting safe care transitions: Simulation-based mastery learning to improve communication in times of diagnostic uncertainty

项目摘要 在急诊科（艾德）接受治疗的患者中，至少有37%的患者在出院时没有任何症状。 明确的诊断，从而留下了诊断不确定性的遭遇。最近的一项全国性 对医学实习生的调查发现，99%的实习生在出院时遇到了挑战， 诊断不确定的患者，51%的人希望进行正式的沟通培训， 不确定性护理过渡是患者安全的高风险时期， 提供者和患者之间的沟通对于促进患者安全至关重要， 护理过渡培训学员和建立能力的方法 在诊断不确定性期间，需要进行有效的沟通，以提高 艾德出院时的沟通是最常见的护理过渡。基于模拟的掌握 SBML是一种以能力为基础的教育方法，允许学习者发展 通过有意识的练习，掌握技能，结果变化不大。SBML是 最常用于培养对医疗程序的掌握，并已被证明可以提高 病人护理实践。SBML提供了一种开发和测试通信的新方法 医学实习生的能力。这项工作的具体目标是：SA1）定义关键 原则的不确定性沟通能力，SA2）开发一个基于模拟 掌握学习课程，以教授有关诊断的有效患者沟通 3）测试基于模拟的掌握学习课程在以下方面的功效： 在住院医师之间建立诊断不确定性的沟通能力。 这项工作将由一个由患者和专家组成的专家小组指导。 沟通、教育、健康素养、诊断不确定性和模拟。结果和 实施SBML课程的工具将在《关于 诊断不确定性（CADU）工具包，工具针对住院医师项目主任， 其他教育领导人通过国家名单服务。这个项目有可能对 提供者在安全和有效卸货方面的培训和能力 超过三分之一的病人从急诊科出院。

PROJECT SUMMARY At least 37% of patients treated in the emergency department (ED) are discharged without a definitive diagnosis, thus leaving the encounter with diagnostic uncertainty. A recent national survey of medical trainees found that 99% of trainees had experienced challenges discharging patients with diagnostic uncertainty, and 51% wanted formal communication training regarding uncertainty. Transitions of care are high-risk periods for patient safety, and effective communication between providers and patients is essential to promote patient safety during care transitions. Approaches for educating trainees and establishing competency around effective communication during diagnostic uncertainty are needed to improve the quality of communication at ED discharge, the most common transition of care. Simulation based mastery learning (SBML) is a competency-based educational approach that allows learners to develop skills through deliberate practice, resulting in mastery with little variation in outcomes. SBML is most often employed to develop mastery in medical procedures and has been shown to improve patient care practices. SBML offers a novel approach to developing and testing communication competency among medical trainees. The specific aims of this work are: SA1) To define key principles of uncertainty communication competency, SA2) To develop a simulation-based mastery learning curriculum to teach effective patient communication regarding diagnostic uncertainty and SA3) To test the efficacy of a simulation-based mastery learning curriculum in establishing competency in communication of diagnostic uncertainty among resident physicians. This work will be guided by an expert panel composed of patients and experts in patient communication, education, health literacy, diagnostic uncertainty, and simulation. Results and tools for implementing the SBML curriculum will be disseminated in the Communicating About Diagnostic Uncertainty (CADU) toolkit, with tools targeted to residency program directors and other education leaders via national list-serves. This project has potential to significantly impact the training and competency of providers in navigating safe and effective discharge communication for over one third of patients discharged from the emergency department.