When we answer the question “Should family physicians be empathetic?” in the affirmative, we are saying yes to empathy as it is defined by Hojat et al,1 who state that the concept of empathy must be limited to its cognitive and behavioural dimensions. They define it as “a cognitive attribute that involves the ability to understand the patient’s inner experiences and perspective and a capability to communicate this understanding.”
Τετάρτη, 22 Απριλίου 2015
Contextualizing SEGUE: Evaluating Residents’ Communication Skills Within the Framework of a Structured Medical Interview
The SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework is a checklist-style rating scale to facilitate the teaching and assessment of communication skills in medical learners. It has been used for over 15 years, and it is recommended in the Accreditation Council for Graduate Medical Education toolbox of assessment methods for resident training. When it was developed, its ability to provide objective scoring was a substantial improvement over global ratings.
In this article we describe the strengths and weaknesses of the SEGUE Framework. We highlight one residency program's experience with using the SEGUE Framework to evaluate residents' communication skills. Specifically, we cite previous studies and describe our own analysis of resident interviewing performance that demonstrates how the SEGUE Framework did not distinguish between different levels of interviewing skill level in our sample.
Two case examples illustrate how the SEGUE Framework is not an ideal instrument to measure either the quality or the process of medical interviews.
Therefore, we propose a new method of contextualized assessment that builds on the SEGUE Framework. Our system evaluates discrete interviewing behaviors within the context of an ambulatory medical interview. We describe our interview structure, as well as a new instrument (the Wy-Mii, pronounced “why me”), to assess both communication and interpersonal skills. We expect that our new method of contextualized assessment will better differentiate between beginning and advanced levels of medical interviewing skills for residents.
Τετάρτη, 18 Φεβρουαρίου 2015
Background: Women represent 15% of practicing general surgeons. Gender-based discrimination has been implicated as discouraging women from surgery. We sought to determine women’s perceptions of gender-based discrimination in the surgical training and working environment.
Methods: Following IRB approval, we fielded a pilot survey measuring perceptions and impact of gender-based discrimination in medical school, residency training, and surgical practice. It was sent electronically to 1,065 individual members of the Association of Women Surgeons.
Results: We received 334 responses from medical students, residents, and practicing physicians with a response rate of 31%. Eighty-seven percent experienced gender-based discrimination in medical school, 88% in residency, and 91% in practice. Perceived sources of gender-based discrimination included superiors, physician peers, clinical support staff, and patients, with 40% emanating from women and 60% from men.
Conclusions: The majority of responses indicated perceived gender-based discrimination during medical school, residency, and practice. Gender-based discrimination comes from both sexes and has a significant impact on women surgeons.