一项关于反馈以提高医学生患者满意度和问诊技巧的随机对照试验。
A randomised controlled trial of feedback to improve patient satisfaction and consultation skills in medical students.
作者信息
Lai Michelle M Y, Roberts Noel, Mohebbi Mohammadreza, Martin Jenepher
机构信息
Medical Student Programs, Eastern Health Clinical School, Monash University and Deakin University, Level 2, Arnold Street, Box Hill, VIC, 3128, Australia.
Curtin University Medical School, Perth, Australia.
出版信息
BMC Med Educ. 2020 Aug 20;20(1):277. doi: 10.1186/s12909-020-02171-9.
BACKGROUND
The use of feedback has been integral to medical student learning, but rigorous evidence to evaluate its education effect is limited, especially in the role of patient feedback in clinical teaching and practice improvement. The aim of the Patient Teaching Associate (PTA) Feedback Study was to evaluate whether additional written consumer feedback on patient satisfaction improved consultation skills among medical students and whether multisource feedback (MSF) improved student performance.
METHODS
In this single site, double-blinded randomised controlled trial, 71 eligible medical students from two universities in their first clinical year were allocated to intervention or control and followed up for one semester. They participated in five simulated student-led consultations in a teaching clinic with patient volunteers living with chronic illness. Students in the intervention group received additional written feedback on patient satisfaction combined with guided self-reflection. The control group received usual immediate formative multisource feedback from tutors, patients and peers. Student characteristics, baseline patient-rated satisfaction scores and tutor-rated consultation skills were measured.
RESULTS
Follow-up assessments were complete in 70 students attending the MSF program. At the final consultation episodes, both groups improved patient-rated rapport (P = 0.002), tutor-rated patient-centeredness and tutor-rated overall consultation skills (P = 0.01). The intervention group showed significantly better tutor-rated patient-centeredness (P = 0.003) comparing with the control group. Distress relief, communication comfort, rapport reported by patients and tutor-rated clinical skills did not differ significantly between the two groups.
CONCLUSIONS
The innovative multisource feedback program effectively improved consultation skills in medical students. Structured written consumer feedback combined with guided student reflection further improved patient-centred practice and effectively enhanced the benefit of an MSF model. This strategy might provide a valuable adjunct to communication skills education for medical students.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry Number ACTRN12613001055796 .
背景
反馈的运用一直是医学生学习中不可或缺的一部分，但评估其教育效果的严格证据有限，尤其是患者反馈在临床教学和实践改进中的作用。患者教学助理（PTA）反馈研究的目的是评估额外的关于患者满意度的书面消费者反馈是否能提高医学生的会诊技能，以及多源反馈（MSF）是否能提高学生的表现。
方法
在这项单中心、双盲随机对照试验中，来自两所大学的71名符合条件的一年级临床医学生被分配到干预组或对照组，并随访一个学期。他们在教学诊所与患有慢性病的患者志愿者进行了五次模拟的以学生为主导的会诊。干预组的学生收到了关于患者满意度的额外书面反馈，并结合了引导式自我反思。对照组从导师、患者和同伴那里获得常规的即时形成性多源反馈。测量了学生特征、基线患者评定的满意度得分和导师评定的会诊技能。
结果
参加MSF项目的70名学生完成了随访评估。在最后一次会诊时，两组患者评定的融洽关系均有所改善（P = 0.002），导师评定的以患者为中心程度和导师评定的整体会诊技能也有所改善（P = 0.01）。与对照组相比，干预组导师评定的以患者为中心程度明显更好（P = 0.003）。两组患者报告的痛苦缓解、沟通舒适度、融洽关系以及导师评定的临床技能没有显著差异。
结论
创新的多源反馈项目有效地提高了医学生的会诊技能。结构化的书面消费者反馈与引导式学生反思相结合，进一步改善了以患者为中心的实践，并有效地增强了MSF模式的益处。该策略可能为医学生的沟通技能教育提供有价值的辅助。
试验注册
澳大利亚新西兰临床试验注册编号ACTRN1261
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