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“我不是那个意思……”:一门关于应对医学交流中歧视问题的选修课的设计与评估

"I didn't mean it that way…": Design and evaluation of an elective course on dealing with discrimination in medical communication.

作者信息

Schwaab Lena, Strauß Bernhard, Philipp Swetlana

机构信息

Friedrich Schiller University Jena, University Hospital Jena, Institute for Psychosocial Medicine, Psychotherapy and Psychooncology, Jena, Germany.

出版信息

GMS J Med Educ. 2025 Jun 16;42(3):Doc40. doi: 10.3205/zma001764. eCollection 2025.

Abstract

OBJECTIVE

Experiences of discrimination in the context of medical care are not uncommon and have a significant impact on the health of those affected. For this reason, an elective course (28 units) on "dealing with discrimination in medical communication" was introduced at University Hospital Jena for medical students in the clinical section, which aims to improve the communicative skills of future doctors with marginalized patients. The course was tested for the first time in the winter semester 2023/24. The evaluation was used to check whether the course is suitable for expanding knowledge and skills in dealing with discrimination, as assessed by the students themselves.

METHODOLOGY

The course includes discrimination-sensitive treatment of blind/visually impaired patients, trans*/non-binary patients, patients with right-wing extremist attitudes and/or conspiracy beliefs, people without health insurance, as well as racism- and trauma-sensitive treatment and the use of language mediation. The course also contained numerous elements for self-reflection and reflection on one's own professional attitude as a doctor. The self-assessment of knowledge and competence gains is based on an online survey at the beginning of the first course and at the end of the last session.

RESULTS

The participating students (N=13) had hardly had any contact with the content of the seminar series through their medical studies, although they rated the relevance for their own practical work as high. The evaluation of the pre- and post-survey showed that completing the course led to significant increases in self-assessed knowledge for all course topics. There was an increase in self-assessed competence, particularly in relation to dealing with blind/visually impaired people, traumatized people and the use of interpreters. The ability to self-reflect and deal with one's own weaknesses, as well as the awareness of recognizing discrimination, was rated significantly higher also.

CONCLUSION

The newly designed elective subject could help to subjectively improve medical students' knowledge and skills in dealing with discrimination in medical communication. The findings thus provide a good basis for the development of further teaching concepts.

摘要

目的

在医疗环境中遭受歧视的经历并不罕见,且对受影响者的健康有重大影响。因此,耶拿大学医院为临床专业的医学生开设了一门选修课程(28个单元)“应对医疗沟通中的歧视”,旨在提高未来医生与边缘化患者的沟通技巧。该课程于2023/24冬季学期首次进行测试。此次评估旨在检验该课程是否适合扩展学生在应对歧视方面的知识和技能,评估由学生自行完成。

方法

该课程包括对盲人/视力受损患者、跨性别/非二元性别患者、持有极右翼极端主义态度和/或阴谋论信仰的患者、没有医疗保险的人进行敏感对待,以及对种族主义和创伤进行敏感处理并运用语言调解。课程还包含许多自我反思以及对自身作为医生的职业态度进行反思的内容。对知识和能力提升的自我评估基于第一节课开始时和最后一节课结束时的在线调查。

结果

参与课程的学生(N = 13)在医学学习过程中几乎没有接触过该系列研讨会的内容,尽管他们认为其与自身实际工作的相关性很高。前后调查评估显示,完成该课程后,所有课程主题的自我评估知识都有显著增加。自我评估能力有所提高,特别是在与盲人/视力受损者、受创伤者打交道以及使用口译员方面。自我反思和应对自身弱点的能力,以及识别歧视的意识也得到了显著更高的评分。

结论

新设计的选修科目有助于主观上提高医学生在应对医疗沟通中歧视方面的知识和技能。这些发现为进一步发展教学理念提供了良好基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8e99/12286879/2f9e1e8efdb3/JME-42-40-t-001.jpg

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