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利用标准化患者方法评估医学生医患沟通的工作坊。

Evaluation of an interprofessional clinician-patient communication workshop utilizing standardized patient methodology.

机构信息

Department of Orthopaedic Surgery, Scott and White Healthcare, Temple, Texas 76508, USA.

出版信息

J Surg Educ. 2013 Jan-Feb;70(1):95-103. doi: 10.1016/j.jsurg.2012.06.018. Epub 2012 Aug 14.

DOI:10.1016/j.jsurg.2012.06.018
PMID:23337677
Abstract

OBJECTIVE

Communication and interpersonal skills (CIS) are one of the 6 general competencies required by the Accreditation Council for Graduate Medical Education (ACGME). The clinician-patient communication (CPC) workshop, developed by the Institute for Healthcare Communication, provides an interactive opportunity to practice and develop CIS. The objectives of this study were to (1) determine the impact of a CPC workshop on orthopedic surgery residents' CIS (2) determine the impact of physician alone or incorporation of nursing participation in the workshop, and (3) incorporate standardized patients (SPs) in resident training and assessment of CIS.

METHODS

Stratified by training year, 18 residents of an Orthopaedic Surgery Residency Program were randomized to a CPC workshop with only residents (group A, n = 9) or a CPC workshop with nurse participants (group B, n = 9). Data included residents' (1) CIS scores as evaluated by SPs and (2) self-reports from a 25-question survey on perception of CIS. Data were collected at baseline and 3 weeks following the workshop.

RESULTS

Following the workshop, the combined group (group A and B) felt more strongly that the ACGME should require a communication training and evaluation curriculum (post mean = 52.7, post-pre difference = 15.94, p = 0.026). Group A residents felt more strongly that communication is a learned behavior (post mean = 82.7, post-pre difference = 17.67, p = 0.028), and the addition of SPs was a valuable experience (post mean = 59.3, post-pre difference = 16.44, p = 0.038). Group B residents reported less willingness to improve on their communication skills (post-mean = 79.7, post-pre difference = -7.44, p = 0.049) and less improvement in professional satisfaction in effective communication than group A (post mean group A = 81.9, group B = 83.6, post-pre difference group A = 7.11, group B = 1.89, p = 0.047). Few differences between groups regarding CIS scores were detected.

CONCLUSIONS

While there was no demonstrable difference regarding CIS, our study indicates that participants valued the importance of communication training and found SPs to be a valuable addition. The addition of interprofessional participation appeared to detract from the experience. Further study is warranted to elucidate the variables associated with interprofessional education within the context of CIS training and assessment using SPs in residency.

摘要

目的

沟通和人际交往能力(CIS)是研究生医学教育认证委员会(ACGME)要求的 6 项通用能力之一。由医疗保健沟通研究所开发的临床医生-患者沟通(CPC)研讨会提供了一个练习和发展 CIS 的互动机会。本研究的目的是:(1)确定 CPC 研讨会对骨科住院医师 CIS 的影响;(2)确定仅由医生或纳入护士参与研讨会的影响;(3)将标准化患者(SP)纳入住院医师培训和 CIS 评估中。

方法

根据培训年限,18 名骨科住院医师被分层随机分配到仅住院医师参加的 CPC 研讨会(A 组,n = 9)或有护士参与的 CPC 研讨会(B 组,n = 9)。数据包括住院医师的(1)由 SP 评估的 CIS 评分;(2)对 CIS 感知的 25 个问题调查的自我报告。数据在研讨会前和 3 周后收集。

结果

研讨会后,联合组(A 组和 B 组)更强烈地认为 ACGME 应该要求沟通培训和评估课程(后均值 = 52.7,后前差异 = 15.94,p = 0.026)。A 组住院医师更强烈地认为沟通是一种习得的行为(后均值 = 82.7,后前差异 = 17.67,p = 0.028),并且增加 SP 是一次有价值的体验(后均值 = 59.3,后前差异 = 16.44,p = 0.038)。B 组住院医师报告改善沟通技巧的意愿较低(后均值 = 79.7,后前差异 = -7.44,p = 0.049),并且在有效沟通方面的专业满意度改善低于 A 组(后均值 A 组 = 81.9,B 组 = 83.6,后前差异 A 组 = 7.11,B 组 = 1.89,p = 0.047)。在 CIS 评分方面,两组之间几乎没有差异。

结论

虽然 CIS 没有明显差异,但我们的研究表明参与者重视沟通培训的重要性,并认为 SP 是一个有价值的补充。增加跨专业参与似乎会削弱这种体验。需要进一步研究,以阐明在使用 SP 进行住院医师培训和 CIS 评估的背景下,与 CIS 培训和评估相关的跨专业教育的变量。

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