Background

The purpose of this study was to implement an objective structured clinical examination for child neurology trainees for formative feedback regarding communication skills. Effective communication skills are essential and teachable, but tools to formally assess them are limited. An objective structured clinical examination is one such tool, but these examinations have not been developed for child neurology residents.

Methods

We developed nine standardized scenarios that highlighted communication challenges commonly encountered in child neurology. Child neurology trainees participated in three objective structured clinical examination events with three scenarios each over three academic years. Standardized patients portrayed patients or their parents. Each trainee–standardized patient encounter was evaluated by an observing faculty member using a modified Gap-Kalamazoo Communication Skills Assessment Form, the standardized patient who provided direct feedback, and by the participating trainee.

Results

We refined the process of case writing, standardized patient training, and trainee evaluation throughout the three-year pilot. Results indicated rater agreement ranging from 32% to 56%. Trainees reported that the cases were challenging and reflective of real life and that the experience helped improve their communication skills.

Conclusions

An objective structured clinical examination can provide a standardized setting for formative feedback regarding communication skills in child neurology residency programs. The communication challenges posed by common clinical scenarios involving critically ill children, children with undetermined prognosis, and the triad of parent, child, and physician can be realistically modeled in an objective structured clinical examination. We developed cases and a process that were valuable and that we plan to sustain for resident education related to communication skills.

中文翻译：

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儿童神经内科住院医师沟通技巧的客观结构化临床检查

背景

本研究的目的是对儿童神经病学实习生实施客观的结构化临床检查，以获得有关沟通技巧的形成性反馈。有效的沟通技巧必不可少且可教，但正式评估它们的工具有限。客观的结构化临床检查就是这样一种工具，但这些检查尚未针对儿童神经内科住院医师开发。

方法

我们开发了九个标准化场景，突出了儿童神经病学中常见的沟通挑战。儿童神经内科实习生参加了三个客观结构化的临床检查活动，每个活动有三个场景，每个项目超过三个学年。标准化患者描绘患者或其父母。每个受训者与标准化患者的接触都由观察教员使用修改后的 Gap-Kalamazoo 沟通技巧评估表、提供直接反馈的标准化患者以及参与的受训者进行评估。

结果

在整个三年的试点过程中，我们完善了案例编写、标准化患者培训和受训人员评估的流程。结果表明评分者的一致性在 32% 到 56% 之间。受训者报告说，这些案例具有挑战性并反映了现实生活，并且这些经历有助于提高他们的沟通技巧。

结论

客观的结构化临床检查可以为有关儿童神经病学住院医师计划中的沟通技巧的形成性反馈提供标准化设置。可以在客观的结构化临床检查中真实地模拟涉及危重儿童、预后未确定的儿童以及父母、孩子和医生的三合会的常见临床场景所带来的沟通挑战。我们开发了有价值的案例和流程，我们计划维持与沟通技巧相关的住院医师教育。