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Abstract(s)
INTRODUÇÃO: A comunicação de “más notícias” em contexto clínico é uma tarefa extremamente difícil e complexa, a qual está presente no dia-a-dia do médico e é transversal a todas as especialidades.
Ainda não é claro que modelos curriculares e metodologias de ensino e aprendizagem serão os melhores para a formação em comunicação de “más notícias”, sendo importante o feedback estudantil, o qual permitirá obter informações valiosas acerca da eficácia das condições pedagógicas atuais e assim desenvolver iniciativas para melhorar a qualidade do ensino.
O principal objetivo do estudo passa por rever a autoavaliação que os alunos da FCS-UBI fazem da sua formação em comunicação de “más notícias” em contexto clínico e perceber o impacto de diferentes métodos pedagógicos na aprendizagem de conhecimentos e de competências relacionadas com dar “más notícias” em contexto clínico, assim como na confiança dos alunos relativamente a estes conhecimentos e competências.
MATERIAIS E MÉTODOS: É um estudo observacional transversal e com uma parte longitudinal prospetivo, com 2 coortes (aula expositiva e vídeo-aula). Durante o mês de Janeiro de 2018 os alunos do 4º e 5º ano da FCS-UBI participaram numa aula que teve por base o protocolo SPIKES e foram convidados a responder a dois questionários eletrónicos, um antes (Q1) e outro após a aula (Q2). Para efetuar o tratamento estatístico dos dados recorreu-se ao programa SPSS®, versão 23 para Windows®.
RESULTADOS: Responderam a Q1 268 alunos, perfazendo uma taxa de resposta de 82,7%, dos quais 197 (73,5%) eram do sexo feminino e 71 (26,5%) do sexo masculino. A idade média foi de 23,12±2,594 anos. Assistiram à aula e responderam a Q1 e a Q2 240 alunos, perfazendo uma taxa de resposta de 74,1%, dos quais 176 (73,3%) eram do sexo feminino e 64 (26,7%) do sexo masculino. A média de idades foi de 23,06±2,608 anos.
No que toca à formação dos alunos, mais de metade já tiveram alguma formação em comunicação de “más notícias” em contexto clínico, mas apenas de um ponto de vista teórico e ainda 34% afirmam que o tema não terá sido abordado. A autoavaliação que os alunos fazem dos seus conhecimentos, competências e confiança é baixo (valor médio inferior a 4). Apenas uma minoria, 3,4%, refere conhecer o protocolo SPIKES. Cerca de metade dos alunos ainda não presenciou aquilo que se considera uma “má notícia”, facto que pode ajudar a explicar a razão de a maioria dos alunos não se sentir preparado para comunicar “más notícias”. Posto isto a maioria dos alunos avalia o ensino destes conhecimentos e competências por parte da FCS-UBI como sendo insuficiente e atribui uma grande importância em abordar e preparar esta área na formação pré-graduada em medicina. Os alunos ficaram globalmente satisfeitos com a aula sobre “más notícias”, sendo de notar uma satisfação superior no modelo expositivo-ativo com tutor presencial, e aconselhá-lo-iam a futuros anos. A autoavaliação de conhecimentos, competências e confiança que os alunos haviam feito em Q1 (situada na parte negativa da escala) subiu significativamente em Q2, situando-se agora na parte positiva da escala, sendo estas diferenças estatisticamente significativas. Não se verificou uma relação estatisticamente significativa entre a autoavaliação de conhecimentos, competências e confiança e o tipo de modelo de aula assistido. Saliente-se que, em Q1, tendencialmente o sexo masculino sente-se mais confiante do que o sexo feminino para comunicar uma “má notícia”, facto que já não se verifica em Q2.
CONCLUSÃO: Ao longo deste trabalho foram identificadas, na opinião dos alunos, várias falhas na forma como a FCS-UBI tem abordado este tema, nomeadamente, os escassos momentos formativos e a abordagem meramente teórica e desprovida de alguns conteúdos como o protocolo SPIKES. Cerca de metade dos alunos já teriam presenciado a comunicação de uma “má notícia” não estando, contudo, confiantes para o executar se fosse necessário.
A nível dos métodos de ensino testados, os alunos demonstraram uma alta satisfação global pela participação nestas aulas, demonstrando agrado e considerando importante a inclusão de uma aula sobre comunicação de “más notícias” no seu currículo. Importante frisar a subida muito significativa nos conhecimentos, competências e confiança autoavaliadas pelos alunos, após a aula.
Em jeito de conclusão, é essencial fazer alterações no currículo de pré-graduação em medicina de forma a incluir um programa de formação em comunicação de “más notícias” sólido e estruturado, que envolva os vários anos de formação e que tenha uma abordagem teórica e prática, satisfazendo as necessidades dos alunos e a eficácia da aprendizagem.
INTRODUCTION: The breaking of bad news in clinical environments is an extremely nuanced and complex task, one that is present in the everyday activities of a physician, while also being common to all medical specialties. It is not yet clear what curricular models and teaching methodologies are the most effective for training health professionals in order to break bad news. As such, student feedback presents itself as an important asset, giving us valuable information about the efficacy of current pedagogical conditions, which in turn allows the development of better initiatives to improve teaching. The main focus of this study is to review FCS-UBI student self-evaluation after their communication training on “Breaking bad news in a clinical environment”, and to assess the impact of different methodologies on the students’ learning process as well as their own confidence in communicating bad news. MATERIALS AND METHODS: This is a cross-sectional observational study with a prospective longitudinal component, with 2 cohorts (expositional lesson and video-lesson). During the month of January of 2018, medical students of FCS-UBI of the 4th and 5th year participated in a lesson based on the SPIKES protocol, and were then given two quizzes to answer, one before they attended the lesson (Q1) and one after (Q2). The statistical treatment of data was achieved by the usage of the SPSS® program, Windows® version 23. RESULTS: 268 students answered Q1, resulting in a response rate of 82,7%, from which 197 (73,5%) were females and 71 (26,5%) were male. The student average age was of 23,12±2,594 years. 240 students attended the lesson and answered both Q1 and Q2, which resulted in a 74.1% response rate, from which 176 (73,3%) were female and 64 (26,7%) were male. In this group, the average age was of 23,06±2,608 years. Regarding student training, over half had already underwent some sort of training in breaking bad news in a clinical environment, but only from a theoretical point of view, while 34% claimed that the subject was not addressed properly. Student self-evaluation concerning their own knowledge and skills was low (average score under 4). Only a minority of students (3,4%) claimed to be familiar with the SPIKES protocol. Roughly half of the students has not yet witnessed an event they deemed as traumatic or “bad”, which could explain why most students do not feel prepared enough to break bad news. Most students assess the teaching of these knowledge and skills as insufficient, while also attributing great importance to this matter. Students were overall satisfied with the lesson, with greater levels of satisfaction found in the expositional type lesson by a tutor, going so far as to recommend it to fellow colleagues. The negative self-evaluation students has answered in Q1 improved significantly in Q2, which showed positive results (these differences are statistically significant). However, no significant relationship was found between student self-evaluation scores and the type of lesson attended. It should also be noted that, in Q1, male students felt more confident in their ability to break bad news to patients; this was not the case in Q2. CONCLUSION: Throughout this work, in the students’ opinion, various flaws have been found pertaining how FCS-UBI has addressed this issue, namely the scarce learning opportunities as well as the purely theoretical approach (devoid of the SPIKES protocol). About half of the students had already witnessed the breaking of bad news, but did not feel prepared to do so themselves. Students showed overall high satisfaction in attending these lessons, considering them to be of paramount importance in their curriculum. The significant increase in students’ knowledge and skills pertaining this matter cannot be stressed enough. In conclusion, it is essential to reshape the undergraduate curriculum in medicine, in order to include a training program pertaining the breaking of bad news in a clinical environment, one that involves various degree level, with both a theoretical and practical approach, satisfying students’ needs and learning effectiveness levels.
INTRODUCTION: The breaking of bad news in clinical environments is an extremely nuanced and complex task, one that is present in the everyday activities of a physician, while also being common to all medical specialties. It is not yet clear what curricular models and teaching methodologies are the most effective for training health professionals in order to break bad news. As such, student feedback presents itself as an important asset, giving us valuable information about the efficacy of current pedagogical conditions, which in turn allows the development of better initiatives to improve teaching. The main focus of this study is to review FCS-UBI student self-evaluation after their communication training on “Breaking bad news in a clinical environment”, and to assess the impact of different methodologies on the students’ learning process as well as their own confidence in communicating bad news. MATERIALS AND METHODS: This is a cross-sectional observational study with a prospective longitudinal component, with 2 cohorts (expositional lesson and video-lesson). During the month of January of 2018, medical students of FCS-UBI of the 4th and 5th year participated in a lesson based on the SPIKES protocol, and were then given two quizzes to answer, one before they attended the lesson (Q1) and one after (Q2). The statistical treatment of data was achieved by the usage of the SPSS® program, Windows® version 23. RESULTS: 268 students answered Q1, resulting in a response rate of 82,7%, from which 197 (73,5%) were females and 71 (26,5%) were male. The student average age was of 23,12±2,594 years. 240 students attended the lesson and answered both Q1 and Q2, which resulted in a 74.1% response rate, from which 176 (73,3%) were female and 64 (26,7%) were male. In this group, the average age was of 23,06±2,608 years. Regarding student training, over half had already underwent some sort of training in breaking bad news in a clinical environment, but only from a theoretical point of view, while 34% claimed that the subject was not addressed properly. Student self-evaluation concerning their own knowledge and skills was low (average score under 4). Only a minority of students (3,4%) claimed to be familiar with the SPIKES protocol. Roughly half of the students has not yet witnessed an event they deemed as traumatic or “bad”, which could explain why most students do not feel prepared enough to break bad news. Most students assess the teaching of these knowledge and skills as insufficient, while also attributing great importance to this matter. Students were overall satisfied with the lesson, with greater levels of satisfaction found in the expositional type lesson by a tutor, going so far as to recommend it to fellow colleagues. The negative self-evaluation students has answered in Q1 improved significantly in Q2, which showed positive results (these differences are statistically significant). However, no significant relationship was found between student self-evaluation scores and the type of lesson attended. It should also be noted that, in Q1, male students felt more confident in their ability to break bad news to patients; this was not the case in Q2. CONCLUSION: Throughout this work, in the students’ opinion, various flaws have been found pertaining how FCS-UBI has addressed this issue, namely the scarce learning opportunities as well as the purely theoretical approach (devoid of the SPIKES protocol). About half of the students had already witnessed the breaking of bad news, but did not feel prepared to do so themselves. Students showed overall high satisfaction in attending these lessons, considering them to be of paramount importance in their curriculum. The significant increase in students’ knowledge and skills pertaining this matter cannot be stressed enough. In conclusion, it is essential to reshape the undergraduate curriculum in medicine, in order to include a training program pertaining the breaking of bad news in a clinical environment, one that involves various degree level, with both a theoretical and practical approach, satisfying students’ needs and learning effectiveness levels.
Description
Keywords
Clínica. Competências Comunicação de Más Notícias Educação Médica Efetividade Métodos Pedagógicos