医学生问诊时的口头和非口头沟通技巧，包括同理心。
Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students.
机构信息
Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246, Hamburg, Germany.
出版信息
BMC Med Educ. 2018 Jul 3;18(1):157. doi: 10.1186/s12909-018-1260-9.
BACKGROUND
Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender.
METHODS
During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses.
RESULTS
Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy.
CONCLUSIONS
Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.
背景
沟通的言语和非言语方面以及同理心已知对医患互动有重要影响。本研究的目的是分析医学生在问诊过程中言语和非言语沟通技能的使用情况，以及这些沟通方面与同理心和性别之间的相关性。
方法
在一个模拟住院医师第三年第一天的三步骤绩效评估中，30 名医学专业的应届毕业生对 5 名模拟患者进行了病史采集，共产生了 150 个医患互动视频。这些视频由外部评分者使用新开发的言语和非言语沟通观察量表以及经过验证的 CARE 同理心问卷进行分析。使用单因素方差分析、t 检验和双变量相关性进行统计分析。
结果
在女性腹痛患者中，女学生在言语沟通方面的得分显著更高（p<0.05），而男学生在两个病例中开始对话的频率明显更高（p<0.05），且与女学生相比，他们在两个病例中更晚打断患者（p<0.05）。所有学生在女性腹痛患者中提出的 W 问题数量明显更高（p<0.05），且与其他四个病例相比，该患者在访谈开始后被打断的时间更早（p<0.001）。在两个病例中，女学生在非言语沟通方面的得分显著更高（p<0.05），在女性腹痛患者中表现出的同理心显著高于男学生（p<0.05）。总体而言，非言语沟通与言语沟通和同理心显著相关，而言语沟通与同理心之间没有显著相关性。
结论
医学生在绩效评估中表现出沟通行为的差异化，包括言语和非言语方面以及同理心，并且可以在男学生和女学生之间检测到特殊差异。这些结果表明，需要进行明确的沟通培训和反馈，以提高学生对沟通各个方面及其相互作用的认识。
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