Chan C S Y, Wun Y T, Cheung A, Dickinson J A, Chan K W, Lee H C, Yung Y M
Department of Community and Family Medicine, The Chinese University of Hong Kong, 4/F School of Public Health, Prince of Wales of Hospital, Shatin, NT, Hong Kong.
Med Educ. 2003 Jun;37(6):514-26. doi: 10.1046/j.1365-2923.2003.01533.x.
To measure any changes in the communication skills of primary care physicians before and after a part-time Diploma course in Family Medicine.
79 Hong Kong Chinese doctors (46 of whom were local graduates, with an average of 7 years in general practice).
Over the 10-month course in 2000-01, participants had 11 2.5-hour lecture/demonstrations in communication skills, 2 sessions of role play practice in groups of 20, self-analysis of a videotaped interview and skills evaluation. A before-after design measured scores in videotaped simulated patient interviews (rated by a research assistant using a structured observation guide, after standardisation by a psychologist) and scores in Objective Structured Clinical Examinations (OSCE) (rated by experienced family physician examiners with standardised checklists).
There were wide variations in baseline skills, with scores ranging between 24-78 (out of 100) for video and 18-68 for OSCE, which were related to prior training and inversely associated with years after graduation. Significant improvements occurred in both video (from 53 to 61) and OSCE (from 46 to 56) post-course (P < 0.001). The group in the lowest quartile improved from 36 to 54 for video and from 29 to 48 for OSCE, while those in the second lowest quartile improved from 50 to 61 for video and from 44 to 56 for OSCE (F = 12.2, P < 0.001). Doctors who graduated more than 20 years ago made as much improvement as more recent graduates.
Communication skills can be effectively taught to, and improved among experienced Chinese doctors by a combination of large-class teaching and medium-sized group practice with feedback, and without intensive individual supervision.
评估参加兼职家庭医学文凭课程前后基层医疗医生沟通技巧的变化。
79名中国香港医生（其中46名是本地毕业生，平均从事全科医疗工作7年）。
在2000 - 2001年为期10个月的课程中，参与者参加了11次2.5小时的沟通技巧讲座/演示、2次每组20人的角色扮演练习、对录像访谈的自我分析以及技能评估。采用前后对照设计，通过录像模拟患者访谈（由一名研究助理使用结构化观察指南评分，经心理学家标准化）和客观结构化临床考试（OSCE）（由经验丰富的家庭医生考官使用标准化检查表评分）来测量分数。
基线技能差异很大，录像评分在24 - 78分（满分100分）之间，OSCE评分在18 - 68分之间，这与先前的培训有关，且与毕业后的年限呈负相关。课程结束后，录像（从53分提高到61分）和OSCE（从46分提高到56分）均有显著改善（P < 0.001）。最低四分位数组录像评分从36分提高到54分，OSCE评分从29分提高到48分，而次低四分位数组录像评分从50分提高到61分，OSCE评分从44分提高到56分（F = 12.2，P < 0.001）。毕业超过20年的医生与近期毕业的医生取得的进步相当。
通过大班教学、中等规模小组练习及反馈相结合的方式，无需强化个人督导，即可有效地教授有经验的中国医生沟通技巧并使其得到提高。
