Razack Saleem, Meterissian Sarkis, Morin Lucie, Snell Linda, Steinert Yvonne, Tabatabai Diana, Maclellan Anne-Marie
Centre for Medical Education, McGill University, Montreal, Quebec, Canada.
Med Educ. 2007 May;41(5):441-9. doi: 10.1111/j.1365-2929.2007.02722.x.
To determine thematic similarities and differences in the implementation of common-content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes.
Communications skills training based upon the Kalamazoo consensus statement of communication skills in the clinical encounter was implemented in 4 residency programmes. Field notes of the CST sessions in each programme were analysed and coded for themes, considering the domains of Context, Input, Process and Product ('CIPP' methodology). Immediate learning outcomes were quantitatively assessed using retrospective pre/post methodology.
Important differences were noted in the implementation of CST in the 4 disciplines. The 2 surgical disciplines showed relatively less reflective language and greater concentration on straight skill acquisition, whereas the 2 medical disciplines concentrated on the residents' role as teachers of communication skills for buy-in. Thematic similarities between disciplines included similar challenges to being good communicators in practice, as identified by residents (e.g. inadequate time and space), as well as lack of formal training. Quantitative learning outcome data from the educational intervention were significant in all groups (P < 0.05).
Common material in CST can be adapted to different disciplines. By analysing for thematic similarities and differences in implementation in the 4 disciplines, a picture of different pedagogic 'subcultures' emerged, with different behavioural norms and values related to the doctor's role as communicator. In shared core competency training, it may be useful to consider these differences in planning, so that the training may be both sensitive to the behavioural norms of different disciplines, and effective.
确定在医学、外科、儿科以及妇产科住院医师培训项目中，常见内容沟通技能培训（CST）实施过程中的主题异同。
在4个住院医师培训项目中开展基于临床诊疗中沟通技能的卡拉马祖共识声明的沟通技能培训。对每个项目中CST课程的现场记录进行分析，并按照背景、输入、过程和产出（“CIPP”方法）领域进行主题编码。使用回顾性前后对比方法对即时学习成果进行定量评估。
在这4个学科的CST实施过程中发现了重要差异。两个外科专业显示出相对较少的反思性语言，且更专注于直接的技能获取，而两个医学专业则专注于让住院医师充当沟通技能传授者以获得支持。各学科之间的主题相似之处包括住院医师所确定的在实际操作中成为优秀沟通者面临的类似挑战（例如时间和空间不足），以及缺乏正规培训。教育干预的定量学习成果数据在所有组中均具有统计学意义（P < 0.05）。
CST中的通用材料可适用于不同学科。通过分析这4个学科在实施过程中的主题异同，呈现出不同的教学“亚文化”，与医生作为沟通者的角色相关的行为规范和价值观各不相同。在共享核心能力培训中，在规划时考虑这些差异可能会有所帮助，以便培训既能对不同学科的行为规范保持敏感，又能有效。
