Abstract: Objective  A preliminary training course on difficult conversation skills was developed for neurology residents to explore the feasibility and effects of difficult conversation skills training. 
Methods  Two difficult conversation skills training courses focusing on specific clinical scenarios of particular relevance to neurologic practice were conducted among the neurology residents in Peking Union Medical College Hospital, once a month for 2 hours each time. The topics were: giving bad news, communicating with “difficult” patients or family members, discussing not implementing cardiopulmonary resuscitation and other rescue measures, and discussing the hospice care of patients in severe or critical condition with their families. Standardized patients and residents were invited to complete simulation-based teaching and the learning of doctor-patient communication ethics knowledge, skill, and strategies under the guidance of teachers. An anonymous online survey was used to assess residents’ satisfaction with the course. The self-assessment questionnaire of difficult conversation skills was used to analyze the improvement of residents’ skills in 11 dimensions before and after the course. Set the stage, elicit information, give information, understand the patient’s perspective, and end the encounter (SEGUE) was used to assess the communication ability of partial residents after one year of the course.
Results  A total of 14 residents participated in the course, and 12 (85.7%) completed the questionnaire, of which 9 (75.0%) were female, and 10 (83.3%) were junior residents, including first- and second-year residents. Overall, the residents reacted positively to the training course and gained improvements in most aspects addressed in the questionnaire to different extents. All residents who completed the questionnaire were satisfied with the course, and 3 of the 4 residents who completed the SEGUE evaluation got a grade of A.
Conclusions  Difficult conversation skills training using specific clinical scenarios stimulation based on real neurologic cases was well accepted by neurology residents. The residents had a high degree of satisfaction with the course and the course had a positive influence on the participants. Their ability of difficult conversations has been improved to different degrees after the training.

Key words: Communication skill; Difficult conversation; Neurology residency training; Simulation-based teaching

摘要： 目的 在神经科住院医师中开展困难谈话技能培训课程，探究困难谈话技能培训的可行性，并初步探索本课程的效果。
方法 在北京协和医院神经科住院医师中开展2次困难谈话技能培训课程，每月1次，每次2 h。课程主题均为与神经科临床实践相关的具体临床情景，包括：①告知坏消息；②与“困难”患者或家属沟通；③讨论不施行心肺复苏等抢救措施；④与家属讨论重症患者的临终关怀。采用情景模拟教学方法，邀请标准化病人和住院医师在教师指导下完成案例情景模拟，并进行医患沟通伦理知识、技能策略的学习。采用匿名在线调查评估住院医师对本课程的满意度，课程前后采用困难谈话技能自我评估问卷分析住院医师11个维度技能的改善情况。课程结束1年后使用医患沟通技能评价量表（set the stage，elicit information，give information，understand the patient’s perspective，and end the encounter；SEGUE）对部分住院医师的沟通能力进行考核。 
结果 共有14位住院医师参加了困难谈话技能培训课程，12位（85.7%）完成了相关调查评估问卷。完成问卷的住院医师中9位（75.0%）为女性，10位（83.3%）为低年级住院医师（第一年或第二年住院医师）。总体而言，住院医师对本课程反响积极，所有完成问卷的住院医师均对课程表示满意；参与的住院医师在困难谈话技能自我评估问卷涉及的绝大多数维度上均有不同程度改善；4位住院医师完成SEGUE评估，3位获得A级评分。
结论 在神经科住院医师中使用基于真实病例的特定临床情景模拟来开展困难谈话技能培训课程是可行的，住院医师对课程满意度高且课程对其有积极影响，住院医师的困难谈话技能在培训后得到一定提升。

关键词: 沟通技能; 困难谈话; 神经科住院医师培训; 模拟教学