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PubMed1993

Problems encountered in teaching the use of the 65 cm flexible sigmoidoscope in a surgical oncology training program.

Flexible sigmoidoscopy after age 50 has been recommended by the American Cancer Society for colorectal cancer screening. A questionnaire to assess the difficulties encountered in learning to perform this procedure was given to 19 surgical oncology fellows after a 3-month rotation in the Division of Colorectal Surgery. Sixteen (84%) trainees related that between 10-20 flexible sigmoidoscopies were necessary before they felt competent. The most difficult aspect of learning flexible sigmoidoscopy was the torquing technique followed by the ability to determine the location of the proximal bowel lumen. All 19 trainees rated the ability to recognize pathology as not difficult. In this group of surgical trainees, the mean number of flexible sigmoidoscopy performed before competency was established was 15; torquing the shaft of the sigmoidoscope was the most difficult aspect to learn. The majority of the trainees recorded that following the performance of 15-20 endoscopies, torquing became easier.

Clinical Competence↗
PubMed1996

Communication, accrual to clinical trials, and the physician-patient relationship: implications for training programs.

BACKGROUND: Previous studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an "alliance building" that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy. METHODS AND RESULTS: The authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes. CONCLUSIONS: The authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Classification↗