Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
S Afr Fam Pract (2004). 2020 Jul 6;62(1):e1-e9. doi: 10.4102/safp.v62i1.5109.
Training institutions need to ensure that healthcare students learn the skills to conduct person-centred consultations. We studied changes in person-centred practice over time following a quality improvement (QI) intervention among Bachelor of Clinical Medical Practice undergraduate students.
Students were randomised to intervention and control groups. The intervention group received training and did a QI cycle on their own consultation skills. Consultations with simulated patients were recorded during structured clinical examinations in June (baseline) and November (post-intervention) 2015.
Matched consultations for 64 students were analysed. The total SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective and End the encounter scores) were significantly higher in the final assessment compared to baseline for both the whole group and the intervention group (p = 0.005 and 0.015, respectively). The improvement did not differ significantly between intervention and control groups (p = 0.778). Third-year students improved significantly more than second years (p = 0.007).
The person-centred practice (including collaboration) of clinical associate students did improve over the period studied. The results show that students' learning of person-centred practice also happened in ways other than through the QI intervention. There is a need to develop students' collaborative skills during the medical consultation.
培训院校需要确保医学生掌握以患者为中心的问诊技能。我们研究了在临床医疗实践本科学生中实施质量改进(QI)干预措施后,以患者为中心的实践随时间的变化。
学生被随机分为干预组和对照组。干预组接受培训并对自己的问诊技能进行 QI 循环。在 2015 年 6 月(基线)和 11 月(干预后)的结构化临床考试中,使用模拟患者记录问诊。
对 64 名学生的匹配问诊进行了分析。与基线相比,整个组和干预组的最终评估中的 SEGUE(设定阶段、引出信息、提供信息、理解患者视角和结束问诊评分)总分均显著更高(p = 0.005 和 0.015)。干预组和对照组之间的改善无显著差异(p = 0.778)。三年级学生的改善明显大于二年级学生(p = 0.007)。
在研究期间,临床助理学生的以患者为中心的实践(包括协作)确实有所改善。结果表明,学生以患者为中心的实践学习也并非仅通过 QI 干预发生。在医疗问诊中需要发展学生的协作技能。