Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
BMC Med Educ. 2021 May 10;21(1):269. doi: 10.1186/s12909-021-02683-y.
Adequate communication and maintaining a patient-centered approach throughout patient encounters are important skills for medical students to develop. Feedback is often provided by clinical teachers. Patients are seldom asked to provide feedback to students that systematically addresses knowledge and skills regarding communication and patient-centeredness during an encounter. One way for patients to provide feedback to students is through a questionnaire; there is, however, a lack of such validated feedback questionnaires. This study aimed to compose and validate a feedback questionnaire for patients' feedback to medical students regarding students' ability to communicate and apply patient-centeredness in clinical practice.
This study comprises (a) composition of the questionnaire and (b) validation of the questionnaire. The composition included (1) literature review, (2) selection and composition of items and construction of an item pool, (3) test of items' content, and (4) test of the applicability of the questionnaire. The items originated from the Calgary-Cambridge Guide (Kurtz S, Silverman J, Benson J and Draper J, Acad Med 78:802-809, 2003), the 'Swedish National Patient Survey' (National Patient Survey, Primary Health Care, 2020), patient evaluation form by Braend et al. (Tidsskr Nor Laegeforen 126:2122-5, 2006), and additional developed items. The items were further developed after feedback from 65 patients, 22 students, eight clinical supervisors, and six clinical teachers. The validation process included 246 patients who provided feedback to 80 students. Qualitative content analysis and psychometric methods were used and exploratory factor analysis assessed internal validity. Cronbach's alpha was used to test the reliability of the items.
The process resulted in the 19-item 'Patient Feedback in Clinical Practice' (PFCP) questionnaire. Construct validity revealed two dimensions: consultational approach and transfer of information. Internal consistency was high. Thematic analysis resulted in three themes: ability to capture the personal agenda of the consultation, alignment with the consultation, and constructs and characteristics. Students reported that the PFCP questionnaire provided useful feedback that could facilitate their learning in clinical practice.
The results of this study indicate that the questionnaire is a valid, reliable, and internally consistent instrument for patients' feedback to medical students. The participants found the questionnaire to be useful for the provision of feedback in clinical practice. However, further studies are required regarding the PFCP questionnaire applicability as a feedback tool in workplace learning.
对于医学生来说，具备充分的沟通能力并在医患互动中始终坚持以患者为中心至关重要。临床带教老师通常会为学生提供反馈，而患者则很少有机会系统地针对沟通和以患者为中心等方面为学生提供有关其在医患互动中的表现的反馈。患者为学生提供反馈的一种方式是填写问卷，但目前尚缺乏此类经过验证的反馈问卷。本研究旨在编制并验证一份用于患者为医学生提供反馈的问卷，以评估学生在临床实践中沟通能力和以患者为中心能力。
本研究包括（a）问卷编制和（b）问卷验证。问卷编制包括（1）文献回顾，（2）项目选择与组合以及项目库构建，（3）项目内容测试，以及（4）问卷适用性测试。这些项目来源于卡尔加里-剑桥指南（Kurtz S、Silverman J、Benson J 和 Draper J，Acad Med 78:802-809, 2003）、“瑞典国家患者调查”（National Patient Survey，初级保健，2020 年）、Braend 等人的患者评估表（Tidsskr Nor Laegeforen 126:2122-5, 2006 年）以及其他开发的项目。在收到 65 名患者、22 名学生、8 名临床督导和 6 名临床教师的反馈后，对这些项目进行了进一步的开发。验证过程包括 246 名患者为 80 名学生提供反馈。采用定性内容分析和心理测量学方法，使用探索性因子分析评估内部有效性。克朗巴赫 α用于测试项目的可靠性。
该过程产生了 19 项“临床实践中的患者反馈”（PFCP）问卷。结构效度显示有两个维度：咨询方法和信息传递。内部一致性较高。主题分析产生了三个主题：能够捕捉咨询的个人议程、与咨询保持一致，以及构建和特征。学生报告说，PFCP 问卷提供了有用的反馈，可以促进他们在临床实践中的学习。
本研究结果表明，该问卷是一种有效的、可靠的、内部一致的工具，可用于患者为医学生提供反馈。参与者认为该问卷在临床实践中提供反馈非常有用。然而，关于 PFCP 问卷作为工作场所学习中反馈工具的适用性，还需要进一步的研究。
