Kahan Meldon, Wilson Lynn, Midmer Deana, Borsoi Diane, Martin Dawn
Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
Subst Abus. 2003 Mar;24(1):5-16. doi: 10.1080/08897070309511529.
The purpose of this study was to determine whether a skills-based workshop will improve medical students' management of problem drinking and alcohol dependence in simulated patients. Seventy-six 3rd and 4th year Ontario medical students were randomized to receive a 3-h workshop on either problem drinking and alcohol dependence or depression (control condition). Students then completed eight simulated office visits (OSCE stations) with simulated patients presenting with depression, problem drinking or alcohol dependence. Examiners completed a checklist of the questions asked and advice given by the student, and simulated patients and examiners completed a global rating scale. Four months later, students were sent a survey on their knowledge, attitudes, and behavior towards patients with alcohol problems. The alcohol group received significantly higher assessment and management checklist scores and global rating scores than did the depression group (p < 0.01) and performed better on almost all aspects of clinical management of both problem drinking and alcohol dependence. On the follow-up survey (n = 55) the alcohol group showed a significant increase in beliefs about self-efficacy in managing alcohol problems (p < 0.05) and had greater knowledge of reduced drinking strategies, but the two groups did not differ on other measures. A skills-based workshop causes marked short-term improvements in medical students' management of problem drinking and alcohol dependence, an increase from baseline to postworkshop in self-efficacy beliefs that was sustained through to follow-up, and greater knowledge of reduced drinking strategies. Repeated reinforcement of clinical skills may be required for a long-term impact on clinical behavior.
本研究的目的是确定一个基于技能的工作坊是否会改善医学生在模拟患者中对问题饮酒和酒精依赖的管理。76名安大略省三、四年级医学生被随机分为两组，一组接受为期3小时的关于问题饮酒和酒精依赖的工作坊，另一组接受关于抑郁症的工作坊（对照条件）。学生们随后完成了八次模拟门诊（客观结构化临床考试站），模拟患者表现为抑郁症、问题饮酒或酒精依赖。考官完成了一份关于学生提问和给出建议的清单，模拟患者和考官完成了一份整体评分量表。四个月后，向学生发送了一份关于他们对酒精问题患者的知识、态度和行为的调查问卷。酒精组在评估和管理清单得分以及整体评分得分上显著高于抑郁症组（p < 0.01），并且在问题饮酒和酒精依赖的临床管理的几乎所有方面表现更好。在后续调查（n = 55）中，酒精组在管理酒精问题的自我效能感信念方面有显著增加（p < 0.05），并且对减少饮酒策略有更多的了解，但两组在其他测量指标上没有差异。一个基于技能的工作坊能使医学生在问题饮酒和酒精依赖的管理上取得显著的短期改善，从基线到工作坊后自我效能感信念增加，并持续到随访期，同时对减少饮酒策略有更多的了解。可能需要反复强化临床技能才能对临床行为产生长期影响。
