Evans B J, Coman G J, Goss B
Monash University, Caulfield, Victoria, Australia.
Med Educ. 1996 Mar;30(2):121-8. doi: 10.1111/j.1365-2923.1996.tb00729.x.
In more traditional medical education, medical students took a patient's medical history by asking a series of sequenced, routine questions, covering presenting medical problem(s); medical history; social and personal history; systems review; and physical examination. Following this process, the student then attempted to derive the patient's medical problems. This inductive problem-solving paradigm may not assist students to prepare for their future interviewing needs, given doctors use a hypothetico-deductive, problem-solving approach when interviewing patients and numerous researchers have developed specialized communication skills training programmes designed to enhance students' interviewing skills. Students given specific consulting skills training have tended to show significantly greater interpersonal effectiveness and improved interview behaviours compared with students who experience traditional patient clerking training. These improvements in interviewing tend to persist over the period of students' medical training. The aim of the present study was to determine whether specialized communication skills training helped students elicit greater quantity and quality of information from patients and if so, whether such information assisted students in improving their diagnostic skills. Videotaped history-taking interviews conducted by students trained in communication skills and untrained (control) students were rated for their interview efficiency. A comparison of ratings given by experimentally naive, independent observers revealed that trained students were more efficient, but took no longer than their control group counterparts to elicit fuller, more relevant information. However, the student groups did not differ in the accuracy or scope of their medical diagnoses. It is argued that students' lack of medical knowledge in this early phase of their clinical training militated against their being able to use their interviewing competence to derive more potentially accurate medical diagnoses.
在更为传统的医学教育中，医学生通过询问一系列按顺序排列的常规问题来获取患者的病史，这些问题涵盖当前的医疗问题、病史、社会和个人史、系统回顾以及体格检查。按照这个流程，学生随后试图推导患者的医疗问题。鉴于医生在问诊患者时采用的是假设 - 演绎的解决问题方法，并且众多研究人员已经开发出专门的沟通技能培训项目以提高学生的问诊技能，这种归纳式的解决问题范式可能无法帮助学生为他们未来的问诊需求做好准备。与接受传统患者诊疗培训的学生相比，接受特定咨询技能培训的学生往往表现出显著更高的人际效能和改善的问诊行为。这些问诊方面的改善在学生的医学培训期间往往会持续存在。本研究的目的是确定专门的沟通技能培训是否有助于学生从患者那里获取更多数量和更高质量的信息，如果是这样，这种信息是否有助于学生提高他们的诊断技能。对接受沟通技能培训的学生和未接受培训的（对照组）学生进行的录像病史采集问诊进行了问诊效率评分。由没有经验的独立观察者给出的评分比较显示，接受培训的学生效率更高，但在获取更全面、更相关信息时所用时间并不比对照组学生长。然而，这两组学生在医学诊断的准确性或范围方面没有差异。有人认为，学生在临床培训的这个早期阶段缺乏医学知识，这不利于他们利用问诊能力得出更有可能准确的医学诊断。
