O'Keefe M, Sawyer M, Roberton D
University of Adelaide Department of Paediatrics Women's and Children's Hospital, North Adelaide South Australia, Australia.
Med Educ. 2001 Jul;35(7):637-44. doi: 10.1046/j.1365-2923.2001.00971.x.
Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes.
To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations.
Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice.
Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01).
Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.
向医学生提供有关其问诊技巧的反馈是教学计划的重要组成部分。关于母亲对医学生儿科问诊的看法,尤其是关于母亲认为成功问诊的关键要素的信息非常少。以患者为中心的问诊是一种强调积极寻求患者观点的模式。据报道,与适当的临床技能相结合,它能促进更好的健康结果。
研究医学生更高的临床能力和更频繁地使用以患者为中心的技巧是否与更高的母亲满意度、母亲对医学生人际技能的更高评价以及母亲对相关诊断和治疗建议的更好回忆相关。
根据实际的高年级医学生问诊创建了两个标准化的“医学生”录像问诊。与问诊B相比,问诊A展示了更高的学生临床能力和更高的以患者为中心程度。11位参加教学全科诊所的母亲观看了这两个录像问诊,然后使用问卷进行评分。
与问诊A相关的平均得分显著更高,表明母亲满意度更高(所有测量指标P < 0.01)。问诊A后对诊断和管理的准确回忆也显著更高(平均诊断回忆,问诊A为35%,问诊B为14%,P < 0.01;平均管理回忆,问诊A为95%,问诊B为57%,P < 0.01)。
在医学生进行更具临床能力和以患者为中心的问诊后,母亲的满意度和回忆更好。母亲对学生问诊的评分可作为一种额外的评估方法,同时也可为医学生提供关于其问诊技能发展的反馈。