Verheijden Michelle, Timmerman Angelique, de Buck Dorien, de Bruin Anique, van den Eertwegh Valerie, van Dulmen Sandra, Essers Geurt T J M, van der Vleuten Cees, Giroldi Esther
Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
Adv Health Sci Educ Theory Pract. 2025 Sep;30(4):1231-1255. doi: 10.1007/s10459-024-10403-6. Epub 2024 Dec 17.
Doctor-patient communication is a core competency in medical education, which requires learners to adapt their communication flexibly to each clinical encounter. Although conceptual learning models exist, information about how skilled communication develops over time is scant. This study aims to unpack this process of communication learning and to identify its facilitators. We conducted a longitudinal qualitative study employing a constructivist grounded theory approach in a General Practice training setting. Over a 6-month period, we closely monitored 8 first-year and 5 third-year trainees (n = 13) by means of clinical observations, stimulated recall interviews and audio diaries. In an iterative process of data collection and analysis, we triangulated these sources across trainees (horizontal analysis) and over time (vertical analysis) to identify how themes evolved. This analysis led us to the construction of a six-stage cyclic conceptual model during which trainees: (1) have an impactful experience; (2) become aware of own communication; (3) look for alternative communication behaviours; (4) experiment with new behaviours; (5) evaluate the effectiveness; and (6) internalise the new communication behaviours. Additionally, conditions were found to support learning and reflection. Becoming a skilled communicator seems to require a continuous approach, with repeated practice and reflection to adapt and internalise communication in the clinical encounter. Consequently, we recommend that trainees be supported with tailored feedback to strengthen their communication repertoire. Ideally, they should be guided by supervisors who serve as coaches in a safe learning environment with regular, planned learning activities.
医患沟通是医学教育中的一项核心能力，要求学习者根据每次临床接触灵活调整沟通方式。尽管存在概念性学习模型，但关于沟通技能如何随时间发展的信息却很少。本研究旨在剖析沟通学习的这一过程，并确定其促进因素。我们在全科医疗培训环境中采用建构主义扎根理论方法进行了一项纵向定性研究。在6个月的时间里，我们通过临床观察、激发式回忆访谈和音频日记密切监测了8名一年级和5名三年级实习生（n = 13）。在数据收集和分析的迭代过程中，我们在实习生之间（横向分析）以及随时间推移（纵向分析）对这些来源进行三角互证，以确定主题是如何演变的。这一分析使我们构建了一个六阶段循环概念模型，在此模型中，实习生：（1）有一次有影响力的经历；（2）意识到自己的沟通方式；（3）寻找替代沟通行为；（4）尝试新行为；（5）评估有效性；（6）将新的沟通行为内化。此外，还发现了支持学习和反思的条件。成为一名熟练的沟通者似乎需要一种持续的方法，通过反复练习和反思来在临床接触中适应并内化沟通方式。因此，我们建议为实习生提供量身定制的反馈，以增强他们的沟通技能。理想情况下，他们应由在安全的学习环境中担任教练角色并开展定期、有计划学习活动的督导人员进行指导。
