| 基金项目:北京协和医学院教育教学改革项目(2007zlgc0104,2014zlgc0119,2014zlgc0730),北京协和医学院重点课程项目(2014-001-001) |
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| 中文摘要: |
| 目的 比较住院医师与医学生在沟通课程前的医患定位及沟通信心情况，为课程的推广提供参考。方法 抽取北京协和医学院2009年10月~2013年10月期间开设临床医患沟通课程的331名八年制医学生及308名住院医师，使用自评问卷的方式进行课前评估。结果 对于“建立良好的医患关系”（4.31±0.740比4.03±0.790，P<0.01）、“收集患者完整的病史”（4.34±0.756比4.05±0.707，P<0.01）、“和患者讨论治疗方案”（4.05±0.812比3.60±0.823，P<0.01）、“告知坏消息”（3.85±0.897比3.26±0.907，P<0.01）、“整体的医患沟通能力”（4.23±0.796比3.70±0.808，P<0.01）的信心，住院医师组均高于医学生组。对不同沟通目标的排序，住院医师和医学生均为：“收集患者完整的病史”最高，“建立良好的医患关系”次之，“和患者讨论治疗方案”再次，“告知坏消息”最低。医生患者定位中，“以患者为中心”的5个条目住院医师组有2项高于医学生组，1项低于医学生组，“以医生为中心”的13个条目中7项住院医师组高于医学生组。结论 住院医师对于医患沟通的自信高于医学生，而“患者为中心”的定位略弱于医学生。医患沟通教学的重点在两个群体分布特点相似。医学生沟通课程设置可以推广到住院医师规范化培训当中，对于住院医师的教学需要强调共情和换位思考能力的培养。 |
| 英文摘要: |
| Objective The purpose of this study was to compare the communication confidence and doctor-patient position between medical students and residents. Methods A sample of 331 medical students and 308 residents in first year resident training who were not trained in Clinical communication skills course were investigated by self-assessment questionnaires. Their answers were compared statistically. Results The order of the different aspects of doctor patient communication skills was same in two groups, “gather complete history”（4.34±0.756，4.05±0.707）first, and “establish good doctor patient relationship”（4.31±0.740，4.03±0.790）, “agree on a plan with patient”（4.05±0.812，3.60±0.823）, “breaking bad news”（3.85±0.897，3.26±0.907）followed. According to the self-assessment, the confidence of “establish good doctor patient relationship”（4.31±0.740 vs. 4.03±0.790，P<0.01）, “gather complete history”（4.34±0.756 vs. 4.05±0.707，P<0.01）“agree on a plan with patient” （4.05±0.812 vs. 3.60±0.823，P<0.01）, “breaking bad news” （3.85±0.897 vs.3.26±0.907，P<0.01）, “general ability at doctor patient communication” （4.23±0.796 vs. 3.70±0.808，P<0.01）were all higher in residents than in medical students. In doctor-patient relationship attitude, residents showed a stronger “doctor centered” style than medical students（60.63±7.665 vs. 3.76±0.828，P<0.01）. Conclusion This study suggested that medical students and resident had similar baseline in doctor patient communication skills. Medical students' communication curriculum needs to take into account the limited clinical experience, training for resident needs to emphasize the capacity of empathy and perspective-taking. |
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