Fortin Auguste H, Haeseler Frederick D, Angoff Nancy, Cariaga-Lo Liza, Ellman Matthew S, Vasquez Luz, Bridger Laurie
Department of Medicine, Office of Education, Yale University School of Medicine, New Haven, CT 06721, USA.
J Gen Intern Med. 2002 Sep;17(9):704-8. doi: 10.1046/j.1525-1497.2002.00628.x.
Teaching medical students to integrate patient-centered skills into the medical interview is challenging. Longitudinal training requires significant curricular and faculty time. Unsupervised students risk harm if they uncover and inappropriately manage psychosocial issues in actual patients. They fear saying the wrong thing in emotionally charged situations. Two half-day workshops for pre-clinical students integrate patient- and physician-centered interviewing. The first occurs early in the first year. The second, late in the second year, presents interview challenges (e.g., breaking bad news). Ten professional actors portray standardized patients (SPs). Groups of 10 to 15 students interview an SP, each eliciting a part of the patient's story. Qualitative evaluation revealed that, for many students, SPs afford the opportunity to experiment without harming real patients. Students view the workshops as effective (mean score for first-year students, 6.6 [standard deviation (SD), 1.0], second-year students, 7.1 [SD, 0.7] on a Likert-type scale: 1 = not at all effective to 8 = very effective).
教授医学生将以患者为中心的技能融入医学问诊具有挑战性。纵向培训需要大量的课程时间和教师时间。如果未受监督的学生在实际患者中发现并不当处理心理社会问题，可能会对患者造成伤害。他们担心在情绪激动的情况下说错话。为临床前学生举办的两个半天工作坊整合了以患者和医生为中心的问诊。第一个工作坊在第一年年初举行。第二个工作坊在第二年年底举行，呈现问诊挑战（例如，告知坏消息）。十名专业演员扮演标准化患者（SP）。每组10至15名学生采访一名标准化患者，每人引出患者故事的一部分。定性评估显示，对许多学生来说，标准化患者提供了在不伤害真实患者的情况下进行试验的机会。学生们认为这些工作坊很有效（在李克特量表上，一年级学生的平均得分是6.6[标准差（SD），1.0]，二年级学生是7.1[SD，0.7]：1=完全无效至8=非常有效）。
