Klein S, Tracy D, Kitchener H C, Walker L G
Centre for Trauma Research, Grampian Primary Care NHS Trust Headquarters, Royal Cornhill Hospital, Aberdeen, U.K.
Eur J Cancer. 2000 Jan;36(2):273-81. doi: 10.1016/s0959-8049(00)00011-3.
The importance of good doctor-patient communication is widely recognised. The aims of this study were to evaluate the immediate effects of the participation of patients with cancer on the attitudes and skills of undergraduate medical students receiving an interview skills training programme, and to assess the effects of the participation of patients with cancer on the attitudes and interview performance of students 2 years later. It was hypothesised that the participation of cancer patients would have specific beneficial effects on attitudes and interview performance. Before participating in a 6-session interview methods course in third year, students were randomised to be taught with patients who had cancer (experimental group) or with patients with other diagnoses (control group). Before and after participating in the course, 233 students (94% response rate) completed an Attitudes Questionnaire. When they reached their fifth year, 54 students again completed the Attitudes Questionnaire and, in addition, made a video recording of an interview with a patient who had gynaecological cancer. These recordings were rated independently by two researchers using the Interview Rating Instrument. Immediately after the course, a number of differences were found between the two groups. For example, students in the experimental group were more likely to consider the ability to listen an extremely important characteristic of hospital doctors and to consider more strongly that trust is an essential part of the doctor-patient relationship. 2 years after the course, the ability of hospital doctors to communicate with patients, and the need for clinical decisions to reflect patients' wishes, were considered to be more important by students in the experimental group, although even 96% of controls felt both these issues were very or extremely important. As hypothesised, the experimental group had better ratings in terms of responding empathically, showing regard and concern for the patient, and assessing the impact of the symptoms on the patient's life. The participation of patients with cancer has beneficial and enduring effects on the attitudes and interview performance of medical undergraduates. Medical schools should consider how best patients with cancer can make an important contribution to communication skills training.
良好的医患沟通的重要性已得到广泛认可。本研究的目的是评估癌症患者参与对接受面试技巧培训项目的本科医学生的态度和技能的即时影响，并评估癌症患者参与对两年后学生的态度和面试表现的影响。据推测，癌症患者的参与将对态度和面试表现产生特定的有益影响。在三年级参加为期6节的面试方法课程之前，学生被随机分为与癌症患者一起学习（实验组）或与其他诊断的患者一起学习（对照组）。在参加课程前后，233名学生（回复率94%）完成了一份态度问卷。当他们到五年级时，54名学生再次完成了态度问卷，此外，还录制了一段对患有妇科癌症患者的面试视频。两名研究人员使用面试评分工具对这些录像进行了独立评分。课程结束后立即发现两组之间存在一些差异。例如，实验组的学生更有可能认为倾听能力是医院医生极其重要的特征，并更强烈地认为信任是医患关系的重要组成部分。课程结束两年后，实验组的学生认为医院医生与患者沟通的能力以及临床决策反映患者意愿的必要性更为重要，尽管即使96%的对照组学生也认为这两个问题非常或极其重要。正如所推测的那样，实验组在共情回应、对患者表示关注和关心以及评估症状对患者生活的影响方面评分更高。癌症患者的参与对医学本科生的态度和面试表现具有有益且持久的影响。医学院校应考虑癌症患者如何能最好地为沟通技能培训做出重要贡献。
