Shapiro Solomon M, Lancee William J, Richards-Bentley Christopher M
Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Canada.
BMC Med Educ. 2009 Feb 22;9:11. doi: 10.1186/1472-6920-9-11.
Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills.
Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater.
Only the external rater, using an instrument designed to assess the students' empathy based on their written responses, showed a time x group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students' communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities.
The lack of strong findings may be partly due to the study's small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students' communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, their management of the doctor-patient relationship, and their ability to give and receive feedback.
有效的医患沟通对患者和医生都有诸多益处。本研究旨在评估多伦多大学治疗性沟通项目（TCom）在提高一年级医学生沟通技巧方面的有效性。
数据收集于1996/97、1997/98、1998/99和1999/00学年。该研究采用重复测量设计，设有一个等待名单对照组：学生被随机分配到9月（N = 38）或2月（N = 41）开始教育干预的组中，后者作为前者的对照组。从学生、标准化病人和外部评估者的角度，在干预前、干预后以及学年末对沟通技巧进行评估。
只有外部评估者，使用一种基于学生书面回复来评估其同理心的工具，显示出时间×组间交互效应（p = 0.039），从而部分支持了TCom提高学生沟通技巧的假设。参与该项目后，学生对自己的评价降低（p = 0.038），这表明自我评估是实际表现的无效衡量指标，或者该项目帮助他们学会更准确地评估自己的能力。
缺乏有力结果可能部分归因于该研究的样本量较小。其他医学院校或专业学校的进一步研究可以评估类似课程对学生沟通技巧以及本研究未测量的其他能力的有效性，例如他们对患者的理解和舒适度、医患关系管理以及给予和接受反馈的能力。
