Nadolski Gregory J, Bell Mary A, Brewer Barbara B, Frankel Richard M, Cushing Herbert E, Brokaw James J
Office of Medical Student Affairs, Indiana University School of Medicine, Indianapolis, Indiana 46202-5120, USA.
BMC Med Educ. 2006 Apr 25;6:23. doi: 10.1186/1472-6920-6-23.
Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations.
We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress.
Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01).
The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction.
有效的医疗保健依赖于多学科协作和团队合作，然而，对于医学生和护士在医院环境中的互动情况知之甚少，而实习医生正是在医院环境中首次作为医疗团队成员获得经验。本研究的目的是评估三年级医学生和护士在临床轮转期间的互动质量。
我们对印第安纳大学医学院的268名医学生和175名在该校主要临床培训基地印第安纳大学医院工作的护士进行了调查。这些学生刚完成第三年的培训。调查问卷包括7个测量医疗团队成员之间“关系协调”的项目和9个测量心理困扰的项目。
68名医学生（25.4%）和99名护士（56.6%）完成了调查。关系协调得分（1至5分，从低到高）用于总体衡量互动质量，结果显示医学生与住院医生的互动最佳（4.16分），与护士的互动最差（2.98分；p<0.01）。相反，护士与其他护士的互动最佳（4.36分），与医学生的互动最差（2.68分；p<0.01）。在心理困扰测量方面（0至4分，从低到高），医学生的人际敏感得分（1.56分）显著高于护士（1.03分；p<0.01），而护士的敌意得分（0.59分）显著高于医学生（0.39分；p<0.01）。
三年级临床轮转期间医学生和护士之间的互动质量较差，这表明医学生没有获得促进最佳医护协作的那种教育体验。医学生和护士经历不同程度的心理困扰，这可能对他们的互动质量产生不利影响。
