Emergency Medicine Resident Perceptions About the Need for Increased Training in Communicating Diagnostic Uncertainty

摘要

IntroductionDiagnostic uncertainty is common in healthcare encounters. Effective communication is important to help patients and providers navigate diagnostic uncertainty, especially at transitions of care. This study sought to assess the experience and training of emergency medicine (EM) residents with communication of diagnostic uncertainty.MethodsThis was a survey study of a national sample of EM residents. The survey questions elicited quantitative and qualitative responses about experiences with and educational preparation for communication with patients in the setting of diagnostic uncertainty.ResultsA sample of 263 emergency medicine residents who had trained at over 87 medical schools and 37 residency programs responded to the survey. Nearly half of participants noted they frequently encountered challenges with these conversations;  63% reported having been “somewhat” or less trained to have these conversations during residency, and 51% expressed a strong desire for more training in how to approach these discussions. Survey respondents reported that prior educational experiences in the communication of diagnostic uncertainty were largely informal and that many residents experience frustration in clinical encounters due to inability to meet patients’ expectations of reaching a diagnosis at the time of discharge.ConclusionThis study found that emergency medicine residents frequently struggle in communicating with patients when there is diagnostic uncertainty upon emergency department discharge and perceived the need for training in how to communicate in these situations. The development of targeted educational strategies for improving communication in the setting of diagnostic uncertainty is consistent with emergency medicine core competencies and may improve patient and provider satisfaction with these clinical encounters.