Gularte Natiele Dutra Gomes, de Campos Velho Maria Teresa Aquino, Gonçalves Kelly Carvalho Silveira, Beschoren Nagele Fatica
Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brasil.
Rev Bras Educ Med. 2019 Oct-Dec;43(4):131-140. doi: 10.1590/1981-52712015v43n4rb20190098. Epub 2019 Oct 14.
Clinical Relationship (CR) is a more comprehensive term than doctor-patient relationship and is currently used to describe the health team's contact with the patient and their families, as well as the team's interaction with each other. To establish satisfactory interpersonal relationships, it is important to bring together communication and empathy skills that play a key role in building the CR. However, such topics are given little attention during medical training, with a more focused study on diseases and treatments. Rigid protocols and guidelines have accounted for a large proportion of undergraduate medical curricula, leaving less time for discussion of more abstract subjects related to the humanities and the subjectivity of patients, a view that is part of people's reality.
To provide spaces and theoretical references for the discussion of topics less addressed in the medical curriculum and to encourage the importance of communication and empathy in health/disease processes.
In view of the importance of providing medical students with humanizing experiences, we have proposed theoretical-practical workshops and conducted a qualitative research in order to evaluate the students' views on learning about CR themes. In total, 33 second-year medical students participated in the project, by voluntary adhesion in response to an invitation distributed via electronic mail. Six theoretical-practical workshops were offered and executed in small groups and addressing topics such as: empathy, mourning, palliative care, end of life and communication of difficult news. The data collection methods were two focus groups conducted at the end of the six meetings encounters and participant observation, the notes from which were taken in a field diary.
Content analysis (Bardin, 2011) was the method chosen to study the results, following transcription and analysis of the speech of the groups. At the end of the analysis, four main categories (and five subcategories) emerged, of which two are highlighted in this article: "Art, cinema and literature evoke feelings: seeking humanism" and "Difficult news in the view of patients - the living experiences". To this end, we used active methodologies such as small group work, use of videos and excerpts from films, music, reports, reading texts and conversation wheels.
The participants' statements showed satisfaction with the proposed theme and methodologies. We therefore evaluated the use of such techniques to sensitize students, leading them to reflect on the importance of empathy and communication in the work of physicians and health staff, developing interpersonal skills.
临床关系（CR）是一个比医患关系更具综合性的术语，目前用于描述医疗团队与患者及其家属的接触，以及团队成员之间的互动。为了建立令人满意的人际关系，将沟通和同理心技能结合起来很重要，这些技能在构建临床关系中起着关键作用。然而，在医学培训期间，此类主题很少受到关注，更多地集中于疾病和治疗的研究。严格的规程和指南在本科医学课程中占了很大比例，留给讨论与人文和患者主观性相关的更抽象主题的时间较少，而这一观点是人们现实生活的一部分。
为医学课程中较少涉及的主题讨论提供空间和理论参考，并强调沟通和同理心在健康/疾病过程中的重要性。
鉴于为医学生提供人性化体验的重要性，我们举办了理论与实践相结合的工作坊，并开展了一项定性研究，以评估学生对学习临床关系主题的看法。共有33名二年级医学生通过自愿报名参与了该项目，报名是对通过电子邮件分发的邀请做出的回应。提供并以小组形式开展了六次理论与实践工作坊，主题包括：同理心、哀伤、姑息治疗、生命终结以及告知坏消息。数据收集方法是在六次会议结束时进行了两个焦点小组讨论以及参与观察，观察记录记在实地日记中。
在对小组发言进行转录和分析之后，选择了内容分析法（巴丁，2011年）来研究结果。分析结束时，出现了四个主要类别（和五个子类别），本文重点突出其中两个：“艺术、电影和文学唤起情感：追求人文精神”以及“患者视角下的坏消息——生活经历”。为此，我们采用了小组活动、播放视频和电影片段、音乐、报告、阅读文本以及使用对话轮等积极的方法。
参与者的陈述表明对所提议的主题和方法感到满意。因此，我们评估了使用此类技巧来提高学生的敏感度，促使他们思考同理心和沟通在医生和医护人员工作中的重要性，进而培养人际交往能力。
