Skillings Jared Lyon, Porcerelli John H, Markova Tsveti
J Grad Med Educ. 2010 Mar;2(1):102-7. doi: 10.4300/JGME-D-09-00030.1.
The SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework is a checklist-style rating scale to facilitate the teaching and assessment of communication skills in medical learners. It has been used for over 15 years, and it is recommended in the Accreditation Council for Graduate Medical Education toolbox of assessment methods for resident training. When it was developed, its ability to provide objective scoring was a substantial improvement over global ratings.
In this article we describe the strengths and weaknesses of the SEGUE Framework. We highlight one residency program's experience with using the SEGUE Framework to evaluate residents' communication skills. Specifically, we cite previous studies and describe our own analysis of resident interviewing performance that demonstrates how the SEGUE Framework did not distinguish between different levels of interviewing skill level in our sample.
Two case examples illustrate how the SEGUE Framework is not an ideal instrument to measure either the quality or the process of medical interviews.
Therefore, we propose a new method of contextualized assessment that builds on the SEGUE Framework. Our system evaluates discrete interviewing behaviors within the context of an ambulatory medical interview. We describe our interview structure, as well as a new instrument (the Wy-Mii, pronounced "why me"), to assess both communication and interpersonal skills. We expect that our new method of contextualized assessment will better differentiate between beginning and advanced levels of medical interviewing skills for residents.
SEGUE（设定场景、引出信息、提供信息、理解患者观点以及结束问诊）框架是一种清单式评分量表，用于促进对医学学习者沟通技能的教学和评估。它已使用超过15年，并且在毕业后医学教育认证委员会用于住院医师培训的评估方法工具包中被推荐。在其开发时，与整体评分相比，它提供客观评分的能力有了显著提高。
在本文中，我们描述了SEGUE框架的优点和缺点。我们强调了一个住院医师项目使用SEGUE框架评估住院医师沟通技能的经验。具体而言，我们引用先前的研究并描述我们自己对住院医师问诊表现的分析，该分析表明SEGUE框架在我们的样本中无法区分不同水平的问诊技能。
两个案例说明了SEGUE框架为何不是衡量医学问诊质量或过程的理想工具。
因此，我们基于SEGUE框架提出了一种情境化评估的新方法。我们的系统在门诊医疗问诊的背景下评估离散的问诊行为。我们描述了我们的问诊结构以及一种用于评估沟通和人际技能的新工具（Wy-Mii，发音为“why me”）。我们期望我们新的情境化评估方法能更好地区分住院医师医学问诊技能的初级和高级水平。
