Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
Patient Educ Couns. 2011 Feb;82(2):226-32. doi: 10.1016/j.pec.2010.03.019. Epub 2010 May 5.
Training in communication can change clinician behaviors, but brief training may function by altering attitudes rather than teaching new skills. We used data from a trial of mental health training for office-based primary care to determine indicators of uptake that predicted parent and child outcomes.
Clinicians (n=50) were randomized to be controls or receive training. Uptake was determined comparing pre- and post-training visits with standardized patients (SPs) coded for skills and patient centeredness. Clinical outcomes were assessed by recruiting and following 403 children/youth ages 5-16 making visits to participants. At 6 months, change in mental health was assessed by parent and youth reports using the Strengths and Difficulties Questionnaire.
Trained clinicians used more agenda setting, time, and anger management skills than controls and showed increased patient centeredness toward SP parents, but not adolescents. Increased patient-centeredness toward parents predicted improvement in child/youth symptoms and functioning (rated by parents), and improvement in youth-rated symptoms. Increased skills alone were not associated with improvement, but patients of clinicians above the mean for both skill and patient-centeredness change improved most.
沟通培训可以改变临床医生的行为，但简短的培训可能通过改变态度而不是教授新技能来发挥作用。我们利用一项针对基于办公室的初级保健心理健康培训的试验数据，确定了预测父母和儿童结果的接受指标。
将临床医生（n=50）随机分为对照组或接受培训组。通过与标准化患者（SP）进行比较，对技能和以患者为中心的标准化患者进行编码，以确定培训前后的就诊情况，以评估接受程度。通过招募并随访 403 名 5-16 岁的儿童/青少年来评估临床结果。在 6 个月时，使用长处和困难问卷（Strengths and Difficulties Questionnaire），通过父母和年轻人报告评估心理健康的变化。
接受培训的临床医生比对照组更多地使用了议程设置、时间和情绪管理技能，并且对 SP 父母的以患者为中心程度有所提高，但对青少年则不然。对父母的以患者为中心程度的提高预测了儿童/青少年症状和功能（由父母评估）的改善，以及青少年自评症状的改善。仅增加技能与改善无关，但技能和以患者为中心程度变化均高于平均值的医生的患者改善最大。
