Benbassat J, Baumal R
JDC-Brookdale Institute, Health Policy Research Program, Jerusalem, Israel.
Am J Med Sci. 2001 Dec;322(6):349-57. doi: 10.1097/00000441-200112000-00008.
We describe an approach for the resolution of difficulties that some preclinical medical students appeared to have when acquiring patient interviewing skills.
Two medical schools in Israel.
Descriptive.
Students' difficulties were related to the inconsistency between the patient-centered approach that was emphasized in the preclinical teaching programs and the disease-centered (biomedical) approach that was practiced on the wards. Others were confused by ambiguous vocabulary and by the multiplicity of rules that they had to remember. Still others appeared to resent attempts to teach them what they thought was elementary courtesy, to reject counterintuitive interviewing rules, and to be bored by the repetitive nature of the practice sessions. TEACHING INTERVENTION: We used an integrated learner- and teacher-centered approach, which is based on the premise that students learn more effectively when autonomous and self-motivated than when responding to instructions from others. Rather than the students being lectured, they were asked to identify the problems in doctor-patient communication and to propose solutions. We conducted live demonstrations of patient- and disease-centered interviews and encouraged students to discuss the advantages and disadvantages of each of them. Lastly, we supervised students as they interviewed patients with increasingly difficult communication problems.
The described approach is consistent with current theories of adult learning. It permits the instructor's input and also supports students' autonomy in identifying and resolving problems in patient interviewing and in choosing the balance between patient- and disease-centered interviewing styles according to the patient's needs. The feasibility of our approach is conditional on the availability of instructors who feel comfortable conducting group discussions, are familiar with the literature on doctor-patient relations, and are experienced enough to demonstrate different interviewing techniques using live patients.
我们描述了一种解决部分临床前医学生在获取患者访谈技巧时遇到困难的方法。
以色列的两所医学院。
描述性研究。
学生们的困难与临床前教学项目中强调的以患者为中心的方法和病房中实践的以疾病为中心（生物医学）的方法之间的不一致有关。其他学生则因模糊的词汇和必须记住的众多规则而感到困惑。还有一些学生似乎反感教授他们认为是基本礼貌的内容，拒绝违反直觉的访谈规则，并且对练习环节的重复性感到厌烦。教学干预：我们采用了一种以学习者和教师为中心的综合方法，其前提是学生自主且有自我动力时比听从他人指示时学习更有效。不是给学生讲课，而是要求他们识别医患沟通中的问题并提出解决方案。我们进行了以患者为中心和以疾病为中心的访谈的现场演示，并鼓励学生讨论每种方法的优缺点。最后，我们在学生访谈沟通问题日益困难的患者时对他们进行监督。
所描述的方法与当前成人学习理论一致。它允许教师提供输入，也支持学生在识别和解决患者访谈中的问题以及根据患者需求在以患者为中心和以疾病为中心的访谈风格之间选择平衡时的自主性。我们方法的可行性取决于是否有教师能够自如地进行小组讨论、熟悉医患关系方面的文献并且有足够经验使用真实患者演示不同的访谈技巧。
