姑息治疗与医学

抽象的

End of Life Decisions: Using Lectures, Small Groups and Standardized Patients to Develop Communication Skills

Scott De La Cruz, Kelly White, Dan Johnson and Eva Aagaard

Study Background: Teaching communication skills to medical students is necessary and challenging. Our aim was to enhance student confidence in and ability to communicate with patients and families, particularly in difficult and complex medical situations.

Methods: Interactive didactics given to 146 third year medical students at the University of Colorado School of Medicine provided content and context for developing advanced communication skills. Students practiced these skills during standardized patient (SP) interactions involving 1) breaking bad news and 2) a family meeting to address goals of care. The course was assessed using: 1) student self-assessment, 2) SP assessment of student’s performance, and 3) results of the medical school graduation questionnaire.

Results: Students felt better prepared to deliver bad news (93.9% either agreed or strongly agreed with this statement), manage family meetings (95.3% agreed or strongly agreed) and communicate with patients and families (95.3% agreed or strongly agreed). More than 80% of students consistently demonstrated key skills during SP encounters including: eliciting understanding, responding to emotion, and avoiding false reassurances. Four percent and 3% of students who completed this curriculum reported that they received inadequate palliative or end of life care instruction compared with 22% and 19% of all students nationally (respectively).

Conclusion: A multimodal medical student curriculum in advanced communication skills is feasible and effectively teaches these skills.