Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, USA.
Patient Educ Couns. 2013 Apr;91(1):85-90. doi: 10.1016/j.pec.2012.10.011. Epub 2012 Nov 13.
In many medical schools, formal training in clinical communication skills (CCS) mainly occurs during pre-clinical training prior to clinical rotations. The current research examined student perceptions of both what and how they learn about CCS during clinical rotations.
During 2008 and 2009, 4th year medical students were invited to participate in interviews focused on learning of CCS during clinical rotations. Interview transcripts were analyzed to identify salient themes in their discussions of CCS in clinical learning experiences.
107 senior students participated and reported learning CCS during clinical rotations mainly by: (1) observing faculty and residents; (2) conducting interviews themselves; and (3) through feedback on patient presentations. Teacher role modeling tended to not reinforce what they had learned pre-clinically about CCS and clinical teachers rarely discussed CCS. Feedback on patient presentations affected students' communication styles, at times prompting them to omit use of CCS they had learned pre-clinically.
Students reported that clinical learning experiences often do not reinforce the CCS they learn pre-clinically.
Disconnects between pre-clinical and clinical CCS teaching need to be reconciled through more explicit pedagogical attention to CCS issues during clinical rotations both in the formal and informal curriculum.
在许多医学院校，临床沟通技巧（CCS）的正式培训主要发生在临床轮转前的临床前培训阶段。本研究考察了学生在临床轮转期间对 CCS 的学习内容和学习方式的看法。
在 2008 年和 2009 年，邀请四年级医学生参加以临床轮转期间学习 CCS 为重点的访谈。对访谈记录进行分析，以确定他们在临床学习经历中讨论 CCS 时的突出主题。
107 名高年级学生参与并报告说，他们主要通过以下方式在临床轮转中学习 CCS：（1）观察教师和住院医师；（2）自己进行访谈；（3）通过对患者陈述的反馈。教师的榜样作用往往不能强化他们在临床前阶段所学的 CCS，临床教师很少讨论 CCS。对患者陈述的反馈影响了学生的沟通方式，有时促使他们省略了在临床前阶段所学的 CCS。
学生报告说，临床学习经历往往不能强化他们在临床前阶段所学的 CCS。
需要通过在临床轮转期间的正式和非正式课程中更加明确地关注 CCS 问题，来弥合临床前和临床 CCS 教学之间的脱节。
