New York University School of Medicine, Division of General Internal Medicine, New York, NY 10016, USA.
Patient Educ Couns. 2010 Aug;80(2):248-52. doi: 10.1016/j.pec.2009.11.015. Epub 2010 Jan 6.
Communication skills are crucial for high-risk behavior screening and counseling. Practicing physicians have limited opportunities to improve these skills. This paper assesses the impact of a continuing medical education (CME) program for Student Health Center clinicians that targeted communication skills, screening practices and patient satisfaction.
Program evaluation included pre- and post-objective structured clinical examinations (OSCE's), chart review, and provider and patient satisfaction surveys. Data were analyzed using paired t-tests and ranked sum tests.
OSCE scores (n=15) revealed significant improvements in communication skills overall (p=0.004) and within specific domains (data gathering: p=0.003; rapport building: p=0.01; patient education: p=0.02), but no change in case-specific knowledge (p=0.1). Participants (n=14) reported high satisfaction with program methods (mean=4.6/5) and content (mean=4.7/5), 70% planning to alter their clinical practice. Chart audits (pre=96, post=103) showed increased screening for smoking (RR 1.65, p=0.03), depressed mood (RR 1.40, p=0.04), anhedonia (RR 1.47, p=0.01), sexual activity (RR 1.73, p=0.002) and drinking (RR 1.77, p=0.04). Sampling of satisfaction among participants' patients (pre n=689, post n=383) detected no increase in already high baseline satisfaction.
This curriculum improved clinicians' relevant skills and screening behavior.
Skills-oriented CME can improve clinicians' communication skills and screening and counseling practices.
沟通技巧对于高危行为筛查和咨询至关重要。执业医师提高这些技能的机会有限。本文评估了一项针对学生健康中心临床医生的继续医学教育（CME）计划对沟通技巧、筛查实践和患者满意度的影响。
方案评估包括前后客观结构化临床考试（OSCE）、病历审查以及提供者和患者满意度调查。使用配对 t 检验和秩和检验分析数据。
OSCE 成绩（n=15）显示沟通技巧总体上有显著提高（p=0.004），且在特定领域也有提高（数据收集：p=0.003；建立融洽关系：p=0.01；患者教育：p=0.02），但案例相关知识无变化（p=0.1）。参与者（n=14）对方案方法（均值=4.6/5）和内容（均值=4.7/5）满意度高，70%计划改变临床实践。病历审核（前=96，后=103）显示吸烟（RR 1.65，p=0.03）、抑郁情绪（RR 1.40，p=0.04）、快感缺失（RR 1.47，p=0.01）、性行为（RR 1.73，p=0.002）和饮酒（RR 1.77，p=0.04）筛查增加。对参与者患者满意度（前 n=689，后 n=383）抽样未发现已有的高基线满意度增加。
该课程提高了临床医生的相关技能和筛查行为。
以技能为导向的 CME 可以提高临床医生的沟通技巧以及筛查和咨询实践。
