Mukohara Kei, Kitamura Kazuya, Wakabayashi Hideki, Abe Keiko, Sato Juichi, Ban Nobutaro
Department of General Medicine, Nagoya University Graduate School of Medicine 65 Tsurumai-cho Showa-ku, Nagoya, 466-8560, Japan.
BMC Med Educ. 2004 Nov 18;4:24. doi: 10.1186/1472-6920-4-24.
Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.
Throughout the academic year 2001-2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating.
There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064).
The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.
在非英语国家,针对医学生沟通技能教学有效性的数据很少。我们进行了一项非随机对照研究,以检验为日本医学生举办的短期强化研讨会是否对与患者的沟通技能有任何影响。
在2001 - 2002学年期间,共有105名五年级学生(18组,每组5至7名学生)一次一组地参加了为期两天的关于医学问诊的小组研讨会。在这一年的中途,对所有五年级学生进行了一场五站式客观结构化临床考试(OSCE)。我们在一个专注于沟通技能的OSCE站点对所有学生与标准化患者的互动进行了录像。两名独立观察员对50名参加研讨会的学生和47名未参加研讨会的学生的录像进行了评分。测量了16项核心沟通技能。评分者之间的分歧由第三位观察员的评分解决。
在一项与理解患者观点相关的特定技能方面,被判定为“可接受”的学生比例存在统计学上的显著差异:询问疾病或问题如何影响患者生活(实验组为53%,对照组为30%,p = 0.02)。在其他15项核心沟通技能方面未观察到差异,尽管在询问患者对疾病或问题的想法的技能方面有改善趋势(60%对40%,p = 0.054)以及一项建立关系的技能;非语言上的专注和共情(87%对72%,p = 0.064)。
本研究结果表明,为日本医学生举办的短期强化小组研讨会可能对与理解患者观点相关的特定沟通技能产生了短期影响。