Abstracts
Résumé
Objectif Cette revue systématique recense les écrits sur les outils pédagogiques ciblant spécifiquement 2 des compétences clés requises par le Collège royal des médecins et chirurgiens du Canada pour devenir psychiatre : la relation thérapeutique et l’empathie, dans le cadre de la psychose.
Méthode Cette recension a été effectuée dans les bases de données Medline via Ovid, PsycInfo (EBSCO) et Scopus en utilisant des combinaisons de termes associés aux outils thérapeutiques, à l’empathie, aux résidents en psychiatrie, aux psychiatres et à la psychose. Deux évaluateurs indépendants ont ensuite examiné 1169 titres et résumés, puis ont conservé 5 articles.
Résultats Tous les articles analysés explorent les habilités de communication, en particulier le Communication Skills Training et 3 des articles portent sur l’une de ses adaptations en psychiatrie : le ComPsych. Il se centre sur l’annonce du diagnostic et du pronostic de la schizophrénie via 5 domaines de compétences, soit l’agenda de la rencontre, l’identification, le questionnaire, l’organisation de l’information et la communication empathique. Ces études utilisent les jeux de rôles, des patients simulés standardisés, des vidéos et de la rétroaction. Une amélioration de la confiance concernant le pronostic est notée quoique l’amélioration obtenue soit inconstante selon les modalités utilisées. Un quatrième article a utilisé le modèle TEMPO (Training to enhance psychiatrist communication with patients with psychosis) qui ressemble au modèle ComPsych, mais inclut, entre autres, l’utilisation de patients réels. TEMPO se base également sur la mesure du Self Repair, un outil déterminant la façon dont une personne s’efforce de parler de manière compréhensible et acceptable pour l’auditeur lors d’une conversation en général et lors de rencontres psychiatriques. Dans l’étude, une amélioration de la relation thérapeutique (effet modéré) autant de la part des psychiatres que des patients est observée. Le dernier article propose un protocole d’étude randomisée contrôlée le SDM-Plus (Shared decision making Plus) une formation sur l’interaction entre les médecins et les patients avec une emphase sur la prise de décision partagée et explicite. Un module concerne les médecins, l’autre les patients.
Conclusion Bien que de nombreux manuels pédagogiques et le Collège royal des médecins et chirurgiens du Canada insistent sur le rôle et l’importance d’établir une relation thérapeutique positive, cette revue systématique de la littérature montre qu’il n’existe qu’un nombre limité d’études sur ce sujet, et que celles-ci sont de faible puissance. Il est donc nécessaire de poursuivre la recherche sur ce sujet et de développer de nouveaux outils pédagogiques. Nous faisons ici quelques recommandations.
Mots-clés :
- relation thérapeutique,
- empathie,
- outils pédagogiques,
- résident,
- psychiatre,
- psychose,
- schizophrénie
Abstract
Objectives This systematic review identifies the literature on educational tools specifically targeting 2 of the keys competencies that a psychiatrist must acquire according to the Royal College of Physicians and Surgeons of Canada: the therapeutic relationship and empathy, in the context of psychosis.
Method This review was carried out in the Medline databases via Ovid, PsycInfo (EBSCO) and Scopus using combinations of terms associated with therapeutic tools, empathy, residents in psychiatry, psychiatrists and psychosis. Two independent reviewers reviewed 1169 titles and abstracts, and retained 5 articles.
Results All of the articles analyzed explore communication skills, in particular communication skills training, and 3 of the articles focus on one of its adaptations in psychiatry: ComPsych. It focuses on the announcement of the diagnosis and prognosis of schizophrenia through 5 areas of expertise: the meeting agenda, identification, questionnaire, organization of information and empathetic communication. These studies use role plays, standardized simulated patients, videos and feedback. An improvement in confidence regarding the prognosis is noted although the improvement obtained is inconsistent depending on the modalities used. A fourth article used the TEMPO model (Training to enhance psychiatrist communication with patients with psychosis) which resembles the ComPsych model, but includes, among other things, the use of real patients. TEMPO is also based on the Self-Repair measurement, a tool that determines how well a person strives to speak in a way that is understandable and acceptable to the listener in a conversation in general and in a psychiatric encounter. In the study, an improvement in the therapeutic relationship (moderate effect) by both psychiatrists and patients was observed. The last article provides a randomized controlled trial protocol for Shared decision making Plus (SDM-Plus) training in physician-patient interaction with an emphasis on shared and explicit decision-making. One module is for doctors, the other for patients.
Conclusion Although many educational manuals and the Royal College of Physicians and Surgeons of Canada stress the role and importance of establishing a positive therapeutic relationship, this systematic review of the literature shows that there are only a limited number of studies on this subject, and they have low statistical power. It is therefore necessary to continue research on this field and to develop new educational tools. Here we make some recommendations.
Keywords:
- therapeutic relationship,
- empathy,
- educational tool,
- resident,
- psychiatrist,
- psychosis,
- schizophrenia
Appendices
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