Purpose According to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture. Methods During a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns). Results Interns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001). Conclusion Interns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.

中文翻译：

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能否让即将到来的美国儿科实习生掌握知情同意的基本沟通技巧？

目的根据美国医学院协会关于进入住院医师的可委托专业活动（EPA），希望入境的住院医师对其可能执行的程序独立获得知情同意。这要求居民不仅要通知他们的患者，还要确保他们理解这些信息。我们评估了 2007 年至 2018 年休斯顿德克萨斯大学健康科学中心的 372 名新来的儿科实习生所展示的沟通技巧，并获得了腰椎穿刺的知情同意。方法 在实习生接受腰椎穿刺知情同意的模拟案例中，标准化患者通过使用李克特 5 点量表从“差”到“优秀”对 7 个基于交流的调查项目进行评分来评估实习生。” 然后，我们将量表转换为数字系统，并计算实习生熟练度分数（每个居民的评分总和）和平均项目表现（所有实习生的平均项目评分）。结果 实习生的平均评分为每 28 分最高分 21.6 分，其中 227 名实习生 (61.0%) 获得 21 分或更高的熟练程度。在比较 EPA 实施前后的组时观察到显着差异（分别为 76.97% 和 47.0% 精通）。项目级别的分析表明，实习生最努力地以热情友好的方式进行会面并鼓励患者提出问题（平均评分分别为 2.97/4 和 2.98/4）。实习生擅长尊重患者并积极倾听问题（平均评分为 3.16，每个）。EPA 实施后，实习生的平均熟练度得分和每个项目的平均评分均显着降低（P<0.001）。结论 实习生在传达知情同意方面表现出中等水平，尽管存在明显的改进机会，例如表现出热情和鼓励性的问题。