Hulsman R L, Harmsen A B, Fabriek M
Academic Medical Center, Department of Medical Psychology, The Netherlands.
Patient Educ Couns. 2009 Feb;74(2):142-9. doi: 10.1016/j.pec.2008.10.009. Epub 2008 Dec 4.
Acquisition of effective, goal-oriented communication skills requires both practicing skills and reflective thinking. Reflection is a cyclic process of perceiving and analysing communication behaviour in terms of goals and effects and designing improved actions. Based on Korthagen's ALACT reflection model, communication training on history taking was designed. Objectives were to develop rating criteria for assessment of the students' level of reflection and to collect student evaluations of the reflective cycle components in the communication training.
All second year medical students recorded a consultation with a simulated patient. In DiViDU, a web-based ICT program, students reviewed the video, identified and marked three key events, attached written reflections and provided peer-feedback. Students' written reflections were rated on four reflection categories. A reflection-level score was based on a frequency count of the number of categories used over three reflections. Students filled out an evaluation questionnaire on components of the communication training.
Data were analyzed of 304 (90.6%) students. The four reflection categories Observations, Motives, Effects and Goals of behaviour were used in 7-38%. Most students phrased undirected questions for improvement (93%). The average reflection score was 2.1 (S.D. 2.0). All training components were considered instructive. Acting was preferred most. Reviewing video was considered instructive. Self-reflection was considered more difficult than providing written feedback to the reflections of peers.
Reflection on communication behaviour can be systematically implemented and measured in a structured way. Reflection levels were low, probably indicating a limited notion of goal-oriented attributes of communication skills.
Early introduction of critical self-reflection facilitates acceptance of an important ability for physicians for continued life-long learning and becoming mindful practitioners.
获得有效、目标导向的沟通技巧既需要练习技巧，也需要反思性思考。反思是一个循环过程，即根据目标和效果来感知和分析沟通行为，并设计改进措施。基于科尔塔根的ALACT反思模型，设计了关于病史采集的沟通培训。目标是制定评估学生反思水平的评分标准，并收集学生对沟通培训中反思循环组成部分的评价。
所有二年级医学生都录制了与模拟患者的会诊过程。在基于网络的信息通信技术程序DiViDU中，学生们观看视频，识别并标记三个关键事件，附上书面反思并提供同伴反馈。学生的书面反思根据四个反思类别进行评分。反思水平得分基于三次反思中使用的类别数量的频数统计。学生填写了一份关于沟通培训组成部分的评估问卷。
对304名（90.6%）学生的数据进行了分析。行为的观察、动机、效果和目标这四个反思类别被使用的比例为7% - 38%。大多数学生提出了无方向的改进问题（93%）。平均反思得分为2.1（标准差为2.0）。所有培训组成部分都被认为具有指导意义。表演最受青睐。观看视频被认为具有指导意义。自我反思被认为比为同伴的反思提供书面反馈更困难。
可以以结构化的方式系统地实施和衡量对沟通行为的反思。反思水平较低，可能表明对沟通技巧的目标导向属性的认识有限。
尽早引入批判性自我反思有助于医生接受持续终身学习和成为有洞察力的从业者的一项重要能力。
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