Lee Katherine B, Vaishnavi Sanjeev N, Lau Steven K M, Andriole Dorothy A, Jeffe Donna B
Washington University School of Medicine, 4444 Forest Park, Ste 6700, St Louis, MO 63108, USA.
J Natl Med Assoc. 2009 Feb;101(2):116-26. doi: 10.1016/s0027-9684(15)30823-3.
We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships.
US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values < .05 were considered significant.
Medical students from 105 schools responded (N = 2395: 55% women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P < .001) and total positive comments (P = .006) differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P < .001), and white students reported receiving more positive comments than black, and South and East Asian students. Race/ethnicity-by-generation (P = .022) and gender-by-generation (P = .025) interaction effects were observed for total negative comments; white first-generation Americans reported receiving the fewest and male immigrants reported receiving the most negative comments.
Demographic differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.
我们检验了学生人口统计学特征、沟通方式与实习期间收到的反馈之间关联的显著性。
2006年4月至7月，邀请至少完成一项必修临床实习的美国医学生完成一项匿名在线调查，询问人口统计学特征、沟通方式（自信和沉默寡言）、反馈（正面和负面）以及实习成绩。使用协方差分析检验自我认定的种族/民族、性别和代际（移民、第一代或第二代美国人）及其双向交互作用对自信、沉默寡言、正面反馈和负面反馈总评论数的影响，并控制年龄、实习成绩以及父母的教育程度；两两比较采用简单对比。双侧P值<0.05被认为具有显著性。
来自105所学校的医学生做出了回应（N = 2395：55%为女性；57%为白人）。男性报告的自信程度高于女性（P = 0.001）。沉默寡言程度（P < 0.001）和正面评论总数（P = 0.006）因种族/民族而异；在两两对比中，黑人、东亚人和美洲原住民/阿拉斯加学生报告的沉默寡言程度高于白人学生（P < 0.001），白人学生报告收到的正面评论多于黑人以及南亚和东亚学生。对于负面评论总数，观察到种族/民族与代际之间的交互作用（P = 0.022）以及性别与代际之间的交互作用（P = 0.025）；第一代美国白人报告收到的负面评论最少，男性移民报告收到的负面评论最多。
学生沟通方式及其收到的反馈中的人口统计学差异凸显了开展文化能力培训以改善医学生与教师互动的必要性，这类似于目前倡导的改善医患互动的培训。
