Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
BMC Med Educ. 2018 Jan 25;18(1):20. doi: 10.1186/s12909-018-1129-y.
Patient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians' patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits.
The study participants were resident physicians at a university hospital in Tokyo. Participants' patient-centered attitudes (as measured by the Patient-Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95).
PPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients' expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score.
As seen in previous studies of medical students, resident physicians' patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians' confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians' attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.
以患者为中心的医疗护理是医学实践中最常讨论的原则之一。然而，人们严重担忧医生对患者的以患者为中心的态度会在医学教育过程中逐渐减弱。这项纵向研究考察了住院医师的以患者为中心的态度及其与患者沟通的信心的变化，并探讨了这两个特征之间的关系。
研究对象为东京某大学附属医院的住院医师。通过自我报告问卷，在住院医师生涯开始时（n=204）和第一年结束时（n=95）评估研究参与者的以患者为中心的态度（由患者-医生取向量表[PPOS]衡量）和与患者沟通的信心（根据医生在医疗访谈中的信心量表[PCMI]衡量）。
PPOS 评分在一年中显著下降，包括与患者分享信息和决策的态度，以及关心患者期望和情绪的态度。关怀态度的转变在性别上存在显著差异。PPOS 评分下降较小者，PCMI 评分的增加幅度更大。
与之前对医学生的研究一样，住院医师在住院医师生涯的第一年中以患者为中心的态度下降，而这种转变可能存在性别差异。与以患者为中心的态度下降幅度较小的人相比，医生与患者沟通的信心增加幅度更大。需要进一步研究以详细了解医生在医学培训过程中的态度、信心和沟通技巧的变化，并制定系统的评估和培训计划。
