How to say "I don't know": development and evaluation of workshops for medical students and surgical residents on communicating uncertainty using the ADAPT framework.

Autor: Duval M; George Washington University School of Medicine and Health Sciences, Washington, D.C. 20007 USA., Zewdie M; University of Virginia School of Medicine, Charlottesville, VA USA., Kapadia MR; Department of Colorectal Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC USA., Liu C; Department of Surgery, Inova Fairfax Medical Campus, Fairfax, VA USA., Mohess D; Department of Medicine, Inova Fairfax Medical Campus, Fairfax, VA USA., Bachman SL; Department of Surgery, Inova Fairfax Medical Campus, Fairfax, VA USA., Dort J; Department of Surgery, Inova Fairfax Medical Campus, Fairfax, VA USA., Newcomb AB; Division of Trauma, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA USA.
Jazyk: angličtina
Zdroj: Global surgical education : journal of the Association for Surgical Education [Global Surg Educ] 2023; Vol. 2 (1), pp. 1. Date of Electronic Publication: 2022 Dec 03.
DOI: 10.1007/s44186-022-00075-4
Abstrakt: Purpose: Uncertainty, or the conscious awareness of having doubts, is pervasive in medicine, from differential diagnoses and the sensitivity of diagnostic tests, to the absence of a single known recovery path. While openness about uncertainty is necessary for shared decision-making and is a pillar of patient-centered care, it is a challenge to do so while preserving patient confidence. The authors' aim was to develop, pilot, and evaluate an uncertainty communication curriculum to prepare medical students and residents to confidently navigate such conversations.
Methods: The authors developed ADAPT , a mnemonic framework to improve student comprehension and recall of the important steps in uncertainty disclosure: assess the patient's knowledge, disclose uncertainty directly, acknowledge patient emotions, plan next steps, and temper expectations. Using this framework, the authors developed, piloted, and evaluated an uncertainty communications course as part of an ongoing communication curriculum for second year medical students in 2020 and with surgical residents in 2021.
Results: Learner confidence in uncertainty communication skills significantly increased post-class. Resident confidence in disclosing uncertainty was significantly correlated with observer ratings of their related communication skills during simulation. Students expressed positive experiences of the class, noting particular appreciation for the outline of steps included in the ADAPT framework, and the ability to observe a demonstration prior to practice.
Conclusions: The ADAPT communication curriculum was effective at increasing learner confidence and performance in communicating uncertainty. More rigorous evaluation of the ADAPT protocol will be important in confirming its generalizability.
Supplementary Information: The online version contains supplementary material available at 10.1007/s44186-022-00075-4.
Competing Interests: Conflict of interestThe author declares that they have no conflict of interest.
(© The Author(s), under exclusive licence to Association for Surgical Education 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
Databáze: MEDLINE
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