PDF(Pubmed)
Abstract：
UNASSIGNED: Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians.
UNASSIGNED: To evaluate the effectiveness of VCA feedback in resident error disclosure skill training.
UNASSIGNED: This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023.
UNASSIGNED: Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2).
UNASSIGNED: Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention\'s effect was examined using analysis of covariance.
UNASSIGNED: A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04).
UNASSIGNED: In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents\' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT06234085.
UNASSIGNED: To evaluate the effectiveness of VCA feedback in resident error disclosure skill training.
UNASSIGNED: This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023.
UNASSIGNED: Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2).
UNASSIGNED: Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention\'s effect was examined using analysis of covariance.
UNASSIGNED: A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04).
UNASSIGNED: In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents\' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT06234085.
摘要：
■居民必须为医疗错误后与患者的有效沟通做好准备。基于视频的通信评估（VCA）是播放患者场景视频的软件，要求医生记录他们会说什么，聘请众包外行人对医生反应的录音进行评分，并向医生提供反馈。
■评估VCA反馈在居民错误披露技能培训中的有效性。
■这种单盲，随机临床试验于2022年7月至2023年5月在7名美国内科和家庭医学住院医师(共10个研究点)进行.参与者是参加所需教学会议的二年级居民。数据分析于2023年7月至12月进行。
■居民在时间1完成了2例VCA病例，并被随机分配到干预措施中。2周后在VCA申请中提供的个人反馈报告，或者控制，直到时间2之后才提供反馈。居民在4周后（时间2）完成了另外2例VCA病例。
■众包外行人小组对公开模拟医疗错误的居民记录进行评分，以5分制评分。报告包括来自外行人评论的学习点。比较了平均时间2评分，以检验以下假设：可以获得时间1表现反馈的居民在时间2的得分高于没有反馈访问的居民。对居民进行了人口统计学特征调查，披露经验，和反馈使用。使用协方差分析检查干预效果。
■共有146名居民（87[60.0％]年龄在25-29岁；60名女性[41.0％]）完成了1次VCA，103人(70.5%)完成时间2VCA(53人随机接受干预，50人随机接受对照)；其中，28人（54.9%）报告审查了他们的反馈。协方差分析发现，干预组和对照组在时间2（均值[SD]得分，3.26[0.45]对3.14[0.39]；差异，0.12；95%CI，0.08-0.48；P=0.01）。在事后比较中，仅限于没有事先披露经验的居民，干预组居民在时间2得分高于对照组(平均[SD]得分，3.33[0.43]对3.09[0.44]；差异，0.24；95%CI，0.01-0.48；P=.007）。时间1表现最差与时间2之前退学的可能性增加相关(赔率比，2.89；95%CI，1.06-7.84；P=.04）。
■在这项随机临床试验中，众包反馈的自我导向审查与内科和家庭医学居民错误披露技能的较高评级相关，特别是对于那些没有现实生活中错误披露经验的人，建议这种反馈可能是住院医师计划的有效方法，以满足他们的要求，使受训者在医疗伤害后与患者沟通。
■ClinicalTrials.gov标识符：NCT06234085。
■评估VCA反馈在居民错误披露技能培训中的有效性。
■这种单盲，随机临床试验于2022年7月至2023年5月在7名美国内科和家庭医学住院医师(共10个研究点)进行.参与者是参加所需教学会议的二年级居民。数据分析于2023年7月至12月进行。
■居民在时间1完成了2例VCA病例，并被随机分配到干预措施中。2周后在VCA申请中提供的个人反馈报告，或者控制，直到时间2之后才提供反馈。居民在4周后（时间2）完成了另外2例VCA病例。
■众包外行人小组对公开模拟医疗错误的居民记录进行评分，以5分制评分。报告包括来自外行人评论的学习点。比较了平均时间2评分，以检验以下假设：可以获得时间1表现反馈的居民在时间2的得分高于没有反馈访问的居民。对居民进行了人口统计学特征调查，披露经验，和反馈使用。使用协方差分析检查干预效果。
■共有146名居民（87[60.0％]年龄在25-29岁；60名女性[41.0％]）完成了1次VCA，103人(70.5%)完成时间2VCA(53人随机接受干预，50人随机接受对照)；其中，28人（54.9%）报告审查了他们的反馈。协方差分析发现，干预组和对照组在时间2（均值[SD]得分，3.26[0.45]对3.14[0.39]；差异，0.12；95%CI，0.08-0.48；P=0.01）。在事后比较中，仅限于没有事先披露经验的居民，干预组居民在时间2得分高于对照组(平均[SD]得分，3.33[0.43]对3.09[0.44]；差异，0.24；95%CI，0.01-0.48；P=.007）。时间1表现最差与时间2之前退学的可能性增加相关(赔率比，2.89；95%CI，1.06-7.84；P=.04）。
■在这项随机临床试验中，众包反馈的自我导向审查与内科和家庭医学居民错误披露技能的较高评级相关，特别是对于那些没有现实生活中错误披露经验的人，建议这种反馈可能是住院医师计划的有效方法，以满足他们的要求，使受训者在医疗伤害后与患者沟通。
■ClinicalTrials.gov标识符：NCT06234085。
