开发评估医学生病理报告解释的评分标准。

Felisha M Davis, Jonathan Bowling, Ashish T Khanchandani, Michael C Larkins, Dmitry Tumin, Sunil Badami, Ahmed K Alomari, Shoujun Chen, Moiz Vora, Yaolin Zhou
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摘要

背景:随着越来越多的患者可以直接获取病理报告,所有医生都必须具备与患者讨论病理报告的能力。目前还没有经过验证的方法来评估在与患者接触时如何交流病理报告结果:试行一个评分标准,评估医学生与标准化病人交流病理报告的情况:该评分标准是根据医学教育病理学能力和医学教育认证委员会病理学住院医师培训里程碑反复制定的。经过简短的培训后,三年级和四年级医学生完成了 2 次标准化病人会诊,提交了模拟的良性和恶性病理报告。由两名病理学家对接触过程进行录像和评分,以计算总体和特定项目的互评可靠性:所有学生都认识到病理报告教学的必要性,而这正是他们医学课程中所缺乏的。恶性病理报告评分的相互间信度很高(类内相关系数为 0.65),但良性病理报告的相互间信度几乎可以忽略不计(类内相关系数为 0)。在恶性报告中,除了讨论区块(盒式磁带)摘要、解释病理报告的目的和承认不确定性外,大多数项目都表现出良好的互评一致性。参加培训的学生(N = 9)认为培训很有价值,因为他们之前接触病理报告的机会有限:这项试点研究证明了使用结构化评分标准评估病理报告与患者沟通的可行性。我们的研究结果还提供了一个可扩展的病理报告沟通培训范例,可将其纳入医学本科课程,使更多医生能够帮助患者理解病理报告。
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Development of a Scoring Rubric Assessing Medical Students' Explanations of Pathology Reports.

Context.—: With increasing availability of immediate patient access to pathology reports, it is imperative that all physicians be equipped to discuss pathology reports with their patients. No validated measures exist to assess how pathology report findings are communicated during patient encounters.

Objective.—: To pilot a scoring rubric evaluating medical students' communication of pathology reports to standardized patients.

Design.—: The rubric was iteratively developed using the Pathology Competencies for Medical Education and Accreditation Council for Graduate Medical Education pathology residency milestones. After a brief training, third- and fourth-year medical students completed 2 standardized patient encounters, presenting simulated benign and malignant pathology reports. Encounters were video recorded and scored by 2 pathologists to calculate overall and item-specific interrater reliability.

Results.—: All students recognized the need for pathology report teaching, which was lacking in their medical curriculum. Interrater agreement was high for malignant report scores (intraclass correlation coefficient, 0.65) but negligible for benign reports (intraclass correlation coefficient, 0). On malignant reports, most items demonstrated good interrater agreement, except for discussing the block (cassette) summary, explaining the purpose of the pathology report, and acknowledging uncertainty. Participating students (N = 9) felt the training was valuable given their limited prior exposure to pathology reports.

Conclusions.—: This pilot study demonstrates the feasibility of using a structured rubric to assess the communication of pathology reports to patients. Our findings also provide a scalable example of training on pathology report communication, which can be incorporated in the undergraduate medical curriculum to equip more physicians to facilitate patients' understanding of their pathology reports.

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