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Nicholas Sevey,Michelle Barratt,Emma Omoruyi 한국보건의료인국가시험원 2020 보건의료교육평가 Vol.17 No.-
Purpose: According to the entrustable professional activities (EPA) for entering residency by the Association of American MedicalColleges, 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 communicationskills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center atHouston, 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 standardizedpatient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We thenconverted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average itemperformance (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 patientwith respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each averageitem 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.
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