Holtedahl K A, Bø B, Hansen A H, Hensrud A, Johansen M L, Prydz P, Thorsen T, Thorvaldsen S N, Bentzen N
Institutt for Samfunnsmedisin Universitetet i Tromsø.
Tidsskr Nor Laegeforen. 1999 Aug 20;119(19):2854-7.
Clinical skills, like questioning and examining a patient, are developed gradually throughout the years of medical training. Basic skills should be mastered on graduation, but the teaching of skills in most medical schools is not systematic. We evaluated a pilot teaching project in a general practice (GP) skills laboratory. Students were randomised to an intervention group and a control group. Teaching was performed in small groups of one GP instructor and six students and consisted of four weekly three-hour sessions. For the control group, teaching was delayed until after evaluation. Evaluation of practical skills and communication skills was made with the students in random order by GP evaluators who did not know about the randomisation procedure. Each skill was scored as satisfactory or not satisfactory for each of five procedural elements. 56 fourth-year medical students volunteered. Evaluation was performed for 19 (68%) students in the training group and 18 (64%) in the control group. The training group performed better on practical skills, average score 9.7 (95% confidence interval 7.4 to 12.1) vs. 5.5 (3.2 to 7.8), (p = 0.01). There was no significant difference for communication skills, 7.7 (5.6 to 9.8) vs. 6.7 (4.6 to 8.7). Teaching clinical skills in a general practice skills laboratory is feasible. Practical skills may improve rapidly, at least for short-time performance, while our brief teaching in communication skills was not proved to be effective.
临床技能,如询问患者和对患者进行检查,是在多年的医学培训过程中逐渐培养起来的。基本技能应在毕业时掌握,但大多数医学院校的技能教学并不系统。我们评估了一个在全科医疗(GP)技能实验室开展的试点教学项目。学生被随机分为干预组和对照组。教学以小组形式进行,每组由一名全科医生教员和六名学生组成,包括每周一次、每次三小时的四次课程。对于对照组,教学推迟到评估之后进行。由不了解随机分组程序的全科医生评估人员对学生的实践技能和沟通技能进行随机评估。对于五个程序要素中的每一个,每项技能的评分分为满意或不满意。56名四年级医学生自愿参加。对培训组的19名(68%)学生和对照组的18名(64%)学生进行了评估。培训组在实践技能方面表现更好,平均得分9.7(95%置信区间7.4至12.1),而对照组为5.5(3.2至7.8),(p = 0.01)。沟通技能方面没有显著差异,分别为7.7(5.6至9.8)和6.7(4.6至8.7)。在全科医疗技能实验室教授临床技能是可行的。实践技能可能会迅速提高,至少在短期内的表现如此,而我们在沟通技能方面的简短教学并未被证明是有效的。