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三阶段调解人教育方案(TIME)以改善台湾临床环境中的医疗纠纷:一项德尔菲研究。

Programme of triple-I mediator education (TIME) to improve medical disputes in clinical settings in Taiwan: a Delphi study.

机构信息

Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center; School of Medicine, National Defense Medical Center, Taipei, Taiwan.

College of Law, National Chengchi University, Taipei, Taiwan.

出版信息

BMJ Open. 2022 Aug 26;12(8):e058880. doi: 10.1136/bmjopen-2021-058880.

Abstract

OBJECTIVES

To establish a training programme to cultivate trainee mediation skills through time investment, skill incorporation and formation of in-house mediation services.

DESIGN

A four-round consensus conference was conducted by a number of seasoned experts selected in the manner of purposive sampling to determine core competences and relevant curricula through the modified Delphi process.

SETTING

Responses collected from enrolled experts through four rounds of the Delphi process from 11 November 2018 to 17 May 2019.

PARTICIPANTS

Onboard seasoned mediators with different specialties.

OUTCOME MEASURES

Items with a median rating of 4 or more on a Likert scale of 1-7 points and 70% or more in agreement were identified as core competence and curricula.

RESULTS

Eleven enrolled experts reached the consensus about the training syllabus based on the 4-round agreement with four pillars of core competence, including 'knowledge base of law', 'internalisation of the denotative and connotative meanings of care', 'effective, smooth and timely communication' and 'conflict resolution'. To grasp the dynamics and diversity of medical disputes on target, it is necessary to have sufficient knowledge and skills. We arrange our course in the order of teaching materials with pure didactics in the former two and with mixed contents comprising lectures and field exercises in the rest two.

CONCLUSIONS

The sample developed a syllabus to train apprentices to take intermediate responses to medical disputes through the skills of conflict resolution and establishment of effective communication to improve the relationship between patients/relatives and medical staff, as a result of eventually reducing the conversion rate from dispute into litigation or alternative pathway. Policy-makers in healthcare and top management in healthcare institutions can use this syllabus to guide their future education and training programme.

摘要

目的

通过时间投入、技能融入和内部调解服务的形成,建立一个培训计划,培养学员的调解技能。

设计

通过 purposive sampling 方式选择了一些经验丰富的专家,进行了四轮共识会议,通过改良 Delphi 流程确定核心能力和相关课程。

设置

从 2018 年 11 月 11 日至 2019 年 5 月 17 日,通过四轮 Delphi 流程从注册专家那里收集回复。

参与者

经验丰富的具有不同专业的调解员。

结果测量

Likert 量表 1-7 分中中位数评分为 4 或以上,且达成 70%或以上共识的项目被确定为核心能力和课程。

结果

11 名参与专家根据四轮协议,就培训教学大纲达成共识,包括四项核心能力支柱:“法律知识库”、“关怀的内涵和外延的内化”、“有效、顺畅和及时的沟通”和“冲突解决”。为了准确把握医疗纠纷的动态和多样性,必须具备足够的知识和技能。我们按照教材的顺序安排课程,前两个纯粹是理论教学,后两个则包含讲座和实地练习。

结论

该样本开发了一份培训大纲,通过解决冲突和建立有效沟通的技能,培训学员对医疗纠纷做出中级回应,从而改善医患关系,最终降低纠纷转为诉讼或其他途径的比例。医疗保健政策制定者和医疗机构高层管理人员可以使用此大纲来指导他们未来的教育和培训计划。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f49e/9422892/2024111eae0b/bmjopen-2021-058880f01.jpg

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