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全科医生培训中的临床同理心:荷兰全科医生培训生的经验和需求。“同理心作为个人成长的一个要素”。

Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. "Empathy as an element of personal growth".

机构信息

Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.

Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.

出版信息

Patient Educ Couns. 2021 Dec;104(12):3016-3022. doi: 10.1016/j.pec.2021.03.030. Epub 2021 Mar 31.

Abstract

OBJECTIVE

Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees' experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees' experiences with clinical empathy during GP training.

METHODS

This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years' training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed.

RESULTS

Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years' training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum.

CONCLUSIONS

GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum.

PRACTICE IMPLICATIONS

More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors.

摘要

目的

临床同理心已被描述为医患沟通中以人为本的关键组成部分。然而,对于普通科医生(GP)受训者对临床同理心、同理心教育以及同理心技能发展的经验和看法知之甚少。本研究旨在探讨受训者在 GP 培训期间的临床同理心经验。

方法

本研究采用焦点小组访谈。通过电子邮件联系了两所荷兰大学的 GP 受训者。焦点小组于 2018 年 4 月至 11 月期间进行。共进行了六次焦点小组讨论:两次与开始培训的受训者,两次与第一年结束的受训者,两次与第三年培训结束的受训者。两名经验丰富的定性研究人员分析了焦点小组。在主题分析中,考虑了不同教育阶段之间的差异和相似之处,并为确定的主题和子主题制定了框架。

结果

共有 35 名 GP 受训者参加。可以确定四个主要主题。开始培训的受训者在个人情感反应对其医疗能力的影响方面存在摩擦。第一年结束的受训者表示,他们在同理心投入和履行相关医疗任务(如遵循 GP 指南)之间达到了平衡。培训结束的受训者认识到临床同理心的行为部分和个人成长之间的相互关系。所有受训者表示,他们在 GP 培训期间对教育的需求发生了变化,并提出了课程改革的建议。

结论

GP 受训者在发展同理心技能和行为方面面临各种障碍。特别是,他们提到了处理个人情感反应的问题。受训者明确表示希望在课程中更加强调同理心,包括理论和技能及情感方面。

实践意义

通过嵌入理论教育、明确关注技能培训以及患者和主管对同理心行为的评估,更加关注同理心。

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