Department of Family and Community Medicine, University of California, San Francisco, CA, USA;
Department of Medicine, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA.
Med Educ Online. 2014 Apr 25;19:22522. doi: 10.3402/meo.v19.22522. eCollection 2014.
To encourage medical students' use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients' level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans.
The intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41); traditional clerkship students comprised the comparison group (n = 185). Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change.
Students found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students' understanding of patients' health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments.
A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills.
为鼓励医学生在核心科室实习中运用以患者为中心的技能，我们实施并评估了一项电话随访课程，重点关注三种沟通行为：根据患者的理解水平调整教育内容、预测障碍以促进依从性，以及让患者重复计划以确保理解。
干预组由两个不同的三年级医学生纵向实习队列（n=41）组成；传统科室实习学生构成对照组（n=185）。干预组学生在门诊或住院患者就诊后一周内通过电话联系一到四位患者，以跟进建议。我们使用问卷调查、焦点小组和临床绩效考试来评估学生的感知、知识和技能以及行为改变。
学生们认为该课程对患者护理有积极影响，尽管一些学生认为电话随访次数过多。学生和教师报告说，学生对患者健康行为、患者教育知识和对电话随访的态度有了改善。很少有学生改变患者教育行为或致电其他患者。在客观评估中，干预组学生在一些沟通技巧上的得分更高。
以患者为中心的沟通课程可以提高学生的知识和技能。尽管一些干预组学生认为他们的电话随访次数过多，但我们的数据表明，更多的电话随访、增加患者的所有权意识以及科室教师的角色扮演可能会确保技能的融入和应用。
