Berglund Leif, von Knorring Johanna, McGrath Aleksandra
Department of Clinical Sciences, Umeå- University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
BMC Med Educ. 2023 Oct 4;23(1):728. doi: 10.1186/s12909-023-04633-2.
Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication.
Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews.
The analysis resulted in a theme 'When theory meets reality- a mismatch in communication'. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students' wishes and perceived needs.
We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.
以患者为中心的沟通技能培训是医学本科教育的一个组成部分，并且已被证明能改善沟通的各个方面。虽然已经对不同教育干预措施的效果进行了研究，但对于在未纳入临床课程的沟通技能课程背景下，从理论学习到临床实践的转化情况却知之甚少。大多数研究聚焦于影响转化的单一因素，而没有从学生自身的全面视角进行考虑。本研究的目的是探讨学生如何体验向临床实践的过渡，以及他们认为在运用以患者为中心的沟通时面临哪些挑战。
15名四年级医学生在从高级沟通技能课程过渡到外科实习3周后，接受了半结构化访谈。采用定性内容分析法对访谈进行分析。
分析得出一个主题“当理论遇到现实——沟通中的不匹配”。它由四个类别组成，涵盖了从理论教育、实践沟通培训、外科实习到学生的愿望和感知需求的转化过程。
我们得出结论，通过理论和实践培训让学生做好准备，应该反映他们进入临床实践时将面临的现实情况。在对医学生群体进行教育时，应考虑到他们倾向于完美主义、身处高绩效环境以及与成绩相关的压力。导师作为榜样、提供指导、给予反馈和提供支持的作用，在促进沟通技能的转化方面起着重要作用。为了在更大程度上实现转化，环境需要促进以患者为中心，并且学生需要更多与患者进行沟通的实践机会。
