期刊论文详细信息
PATIENT EDUCATION AND COUNSELING 卷:105
A shared decision-making communications workshop improves internal medicine resident skill, risk-benefit education, and counseling attitude
Article
Amell, Fred1,5  Park, Caroline2,6  Sheth, Pooja2,7  Elwyn, Glyn3  LeFrancois, Darlene4 
[1] Einstein Montefiore, Internal Med Residency Program, Bronx, NY USA
[2] Einstein Montefiore, Albert Einstein Coll Med, Bronx, NY USA
[3] Dartmouth Coll, Dartmouth Inst Hlth Policy & Clin Practice, Hanover, NH 03755 USA
[4] Einstein Montefiore, Div Gen Internal Med, Dept Med, Bronx, NY USA
[5] Dartmouth Hitchcock Med Ctr, Div Hosp Med, Lebanon, NH 03766 USA
[6] Stanford Univ, Sch Med, Sect Geriatr Med, Palo Alto, CA 94304 USA
[7] Jacobi Med Ctr, Jacobi Montefiore Emergency Med Residency Program, Bronx, NY USA
关键词: Shared decision-making;    Patient communication;    Patient education;    Evidence-based medicine;    Graduate medical education;    Residency education;    Risk-benefit;   
DOI  :  10.1016/j.pec.2021.07.040
来源: Elsevier
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【 摘 要 】

Objective: We assessed the impact of a workshop on first-year medicine residents (PGY1) shared decision-making (SDM) communication skill, risk-benefit education, and attitude.Methods: A SDM skills-focused workshop was integrated into an academic medical center PGY1 ambulatory rotation in 2016-2017. Pre/post recordings of virtual Objective Structured Clinical Examinations (OSCEs) with standardized patients sharing decisions were scored using OPTION5. Risk-benefit education, including decision aid use, was measured. Pre/post surveys assessed SDM practice attitudes and perceived barriers.Results: 31 of 48 (65%) PGY1 workshop attendees completed pre/post OSCEs yielding 62 videos. OPTION5 scores improved from 27/100 pre to 56/100 post (p < 0.001). Pre/post increases in integration of qualitative (15/31 vs 31/31, p < 0.001) and quantitative (3/31 vs 31/31, p < 0.001) risk measures, and decision aids (1/3 vs 31/31, p < 0.001) were observed. Pro-SDM attitude of decisional neutrality increased 16.6% pre to 71.9% post-survey (P < 0.001). Barriers to SDM remain. Conclusion: This PGY1 workshop with virtual OSCEs improved SDM communication skills, the ability to find and provide risk-benefit education, and SDM-facilitating attitude.Practice implications: Residency programs can improve SDM skills, risk-benefit education, and attitudes with a workshop intervention. Perceived time constraints and cognitive biases regarding risk-benefit es-timates should be addressed to ensure quality SDM in practice.(c) 2021 Elsevier B.V. All rights reserved.

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