Whitt Ryan, Toussaint Gregory, Bruce Binder S, Borges Nicole J
Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
J Educ Eval Health Prof. 2014 Aug 17;11:21. doi: 10.3352/jeehp.2014.11.21. eCollection 2014.
As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP) encounters strengthen third-year medical students' communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios) were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students' self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n=215; response rate, 96%) analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students' perception of their confidence and abilities regarding their performance (P<0.05; Bonferroni correction, P<0.006). There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.
随着医学生步入医生角色,临床结果不仅取决于他们对临床知识的掌握程度,还取决于他们与患者及家属沟通的有效性。虽然学生通常有很多机会与成年患者进行临床沟通练习,但在儿科环境中的此类练习却很有限。本研究调查模拟患者(SP)接触是否能增强三年级医学生在儿科实习期间的沟通技巧。在2011年至2013年期间,在美国一所医学院的儿科实习中纳入了三次SP接触(包括3个儿科场景),为学生提供一个安全的场所,以便在有观察和直接反馈的情况下练习高级沟通。三年级医学生参与这些场景,并从观察接触过程的评估者那里获得书面和口头反馈。经机构审查委员会批准,使用一份8项李克特量表问卷在SP接触前后测量学生对执行高级沟通技巧的自我感知信心和能力。使用Wilcoxon配对符号秩检验分析前后问卷(n = 215;回复率96%),结果显示学生对自己在表现方面的信心和能力感知有统计学显著提高(P < 0.05;Bonferroni校正,P < 0.006)。学生在以下方面的信心和自我感知能力有所提高:第一,与年幼患者的儿童及家属沟通;第二,处理涉及家长的对抗性情况;第三,对青少年进行全面的社会心理病史询问;第四,运用循证医学激励家长。