Choosing Words Wisely
| Autor: | Lynfa Stroud, Jonathan Fuller, Geetha Mukerji, Ayelet Kuper, Brian M. Wong, Anne McLeod, Adina Weinerman, Eric Tseng |
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| Rok vydání: | 2020 |
| Předmět: |
Canada
020205 medical informatics Objective structured clinical examination education Psychological intervention 02 engineering and technology Unnecessary Procedures Education Formative assessment 03 medical and health sciences 0302 clinical medicine Credibility 0202 electrical engineering electronic engineering information engineering Rhetorical question Humans Thrombophilia 030212 general & internal medicine Curriculum health care economics and organizations Physician-Patient Relations Medical education Internship and Residency Hematology General Medicine Test (assessment) Abortion Spontaneous Practice Guidelines as Topic Clinical Competence Thematic analysis Psychology |
| Zdroj: | Academic Medicine. 95:275-282 |
| ISSN: | 1040-2446 |
| Popis: | Purpose To characterize how residents employ rhetorical appeals (i.e., the strategic use of communication to achieve specifiable goals) when discussing unnecessary diagnostic tests with patients. Method In 2015, senior hematology residents from 10 Canadian universities participating in a national formative objective structured clinical examination (OSCE) completed a resource stewardship communication station. In this communication scenario, a standardized patient (SP) portrayed a patient requesting unnecessary thrombophilia testing following early pregnancy loss. The authors performed a thematic analysis of audio transcripts using a qualitative description approach to identify residents' rhetorical appeals to logic (rational appeals), credibility, and emotion. Results For persuasive communication, residents (n = 27) relied primarily on rational appeals that fit into 3 categories (with themes) focused on medical evidence (poor utility, professional guidelines and recommendations), avoidance of harm (insurance implications, unnecessary or potentially harmful interventions, patient anxiety), and reassurance to patient (normalizing, clinical pretest probability, criteria for reconsidering testing). Appeals to credibility and emotion were rarely used. Conclusions In an OSCE setting, residents relied predominantly on rational appeals when engaging SPs in conversations about unnecessary tests. These observations yield insights into how recent emphasis within residency education on appropriate test utilization may manifest when residents put recommendations into practice in conversations with patients. This study's framework of rational appeals may be helpful in designing communication curricula about unnecessary testing. Future studies should explore rhetoric about unnecessary testing in the clinical environment, strategies to teach and coach residents leading these conversations, and patients' preferences and responses to different appeals. |
| Databáze: | OpenAIRE |
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