Sideris D A, Tsouna-Hadjis P, Toumanidis S T, Vardas P E, Moulopoulos S D
Med Educ. 1986 Jul;20(4):307-13. doi: 10.1111/j.1365-2923.1986.tb01370.x.
The study aims at measuring doctors' performance while giving therapeutic instructions and testing the effectiveness of an educational technique for affective objectives. For this purpose doctors' performance was analysed into nine components. Twenty-five trainees in internal medicine were observed and rated regarding the nine components, while instructing 40 patients with a chronic disease. Both doctors and patients were then questioned regarding the verbal components of the doctors' performance and the answers were compared to assess the degree of concordance. One to 3 months later the patients were interviewed to assess whether they complied with the instructions or not. Eighteen months later a 4-hour seminar on affective objectives was held, involving listening and small-group discussion on tape-recorded doctor-patient consultations. After completion of the seminar, 25 doctors instructed 39 patients and were assessed as above. The findings suggest that the doctors' performance regarding the nine components did not predict patient compliance. However, sufficient doctor-patient concordance regarding the verbal components of the behaviour significantly predicted patient compliance. Following the seminar, significant improvement was noted in doctors' performance, in doctor-patient communication and in patient compliance. It is concluded that observing the doctors' behaviour independently of the patient does not predict patients' compliance; the analysis of the total doctors' behaviour into components is valid in predicting patient compliance if it is used in order to assess doctor-patient communication; and a programme based on audiotape-assisted education is both simple and effective in improving the trainees' behaviour and communication skills.
该研究旨在衡量医生在给出治疗指导时的表现，并测试一种针对情感目标的教育技术的有效性。为此，将医生的表现分析为九个组成部分。在指导40名慢性病患者时，对25名内科实习医生在这九个组成部分方面进行了观察和评分。然后，就医生表现的言语部分对医生和患者进行询问，并比较答案以评估一致程度。1至3个月后，对患者进行访谈，以评估他们是否遵守了指导。18个月后，举办了一场为期4小时的关于情感目标的研讨会，内容包括收听和小组讨论医患咨询录音。研讨会结束后，25名医生指导了39名患者，并按上述方式进行了评估。研究结果表明，医生在九个组成部分方面的表现并不能预测患者的依从性。然而，在行为的言语部分上医生与患者有足够的一致性则能显著预测患者的依从性。研讨会之后，医生的表现、医患沟通和患者依从性都有显著改善。得出的结论是，独立于患者观察医生的行为并不能预测患者的依从性；如果将医生的整体行为分解为各个组成部分来评估医患沟通，那么这种分析在预测患者依从性方面是有效的；并且基于录音辅助教育的方案在改善实习医生的行为和沟通技巧方面既简单又有效。
