Tokumasu Kazuki, Va Puthiery, Obara Haruo, Rucker Lisa
Department of General Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan.
Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA.
Int J Med Educ. 2024 Dec 5;15:150-158. doi: 10.5116/ijme.6741.f16c.
The purposes of this study were to identify reflective processes from patients' points of view for difficult patient-doctor interactions and learn how the processes made medical students and residents aware of their own medical practice. These processes were compared in two countries (US and Japan).
The study was a descriptive qualitative study utilizing semi-structured interviews. Participants were from US and Japan. We analyzed the data using reflective thematic analysis of the implementation of reflections (from a patient's point of view) into medical clinical education and training from a constructivism paradigm.
We included twenty participants each from US and Japan by convenience sampling. The participants were medical students during clinical clerkship and post graduate year-1, 2, and 3 medical residents. Medical students and residents realized four cognitions (different expectations of patients and doctors, language communication barrier, time restriction and healthcare system challenges) from reflections from patients' perspectives. Subsequently, medical students and residents identified three types of awareness (appropriate communication, empathy, and patient-doctor relationship of trust). During these reflections from patients' perspectives, the medical students and residents had a willingness to change future behavior.
This study revealed one aspect of medical students' and residents' cognitions and awareness of clinical experiences through reflection from patients' perspectives. This cognitive process aligns the ideas of medical students and residents more closely with the patients' perceptions and influences their willingness to change their behavior. This process enables comprehensive realization in person-centered care.
本研究旨在从患者角度识别医患困难互动中的反思过程，并了解这些过程如何使医学生和住院医师意识到自身的医疗实践。在两个国家（美国和日本）对这些过程进行了比较。
本研究是一项采用半结构式访谈的描述性定性研究。参与者来自美国和日本。我们从建构主义范式出发，对将（从患者角度的）反思应用于医学临床教育和培训的数据进行了反思性主题分析。
通过便利抽样，我们从美国和日本各纳入了20名参与者。参与者包括临床实习期间的医学生以及毕业后第1年、第2年和第3年的住院医师。医学生和住院医师从患者角度的反思中认识到了四种认知（患者和医生的不同期望、语言沟通障碍、时间限制和医疗系统挑战）。随后，医学生和住院医师确定了三种意识类型（恰当沟通、同理心和医患信任关系）。在这些从患者角度的反思过程中，医学生和住院医师有改变未来行为的意愿。
本研究通过从患者角度的反思揭示了医学生和住院医师对临床经验的认知和意识的一个方面。这一认知过程使医学生和住院医师的想法与患者的认知更紧密地一致，并影响他们改变行为的意愿。这一过程有助于在以患者为中心的护理中实现全面认识。
