結合關懷技巧訓練與客觀結構式臨床考試對志工培訓之效益

Efficacy of Combining Caring-Skill-Training and Objective Structural Clinical Examination for Patient Care Volunteers

莊淑婷(Shu-Ting Zhuang) ； 葉建宏(Jiann-Horng Yeh) ； 邱浩彰(Hou-Chang Chiu)

《台灣醫學》 22卷4期 (2018/07) Pp. 361-368

https://doi.org/10.6320/FJM.201807_22(4).0002

摘要

本研究獨特處在於以透過模擬關懷困境與反覆演練溝通技巧進行志工訓練，並且首次以醫學教育常見的客觀結構式臨床考試進行訓練前後之成效檢核，研究團隊設計八種關懷困境，與八項溝通技能。總計11名研究參與者，平均年齡58.0±8.5歲，平均擔任志工服務年數10.5±6.7年，期間參加三場訓練從六類關懷困境中反覆練習八項溝通技能，並以客觀結構式臨床考試進行訓練前與後的表現檢核並將檢核表分數進行統計分析，研究結果發現，技能總分表現在「用藥焦慮」情境達顯著差異（p = 0.0001）而「成就感失落」情境（p=0.2865）則未達顯著差異；而整體評量表現，兩類情境皆達顯著差異（p = 0.0409，0.0005）；至於個別分析八項技能的前、後測差異，有「建立關係」（p = 0.0005）、「澄清疑問」（p = 0.0128）、「再次確認疑問與回應」（p = 0.0484）、「維護尊嚴」（p = 0.01 98）、以及「專業告知－醫病溝通」（p = 0.0035）等五項達顯著差異。所以本研究結果認為結合客觀結構式臨床考試之志工訓練方式是可行，並且能做為後續志工訓練設計之實證參考。

關鍵字

肌無力症 ； 溝通技能 ； 客觀結構式臨床考試

並列摘要

This pilot study tried a new way of combining caring-skill-training for the Myasthenia Gravis (MG) Club and objective structural clinical examination (OSCE) to improve coping skills in some difficult communication situations. We designed 8 communication skills and 8 scripts. Six of all scripts were used in 3-session workshop for practicing skills and 2 for OSCE. This study enrolled 11 participant, average age was 58.0 ± 8.5 years and average years for being a volunteer was 10.5 ± 6.7. The checklist score of the script Drug Compliance was with statistical significance (p = 0.0001). In contrast, there was no significant difference in the script Work Overload. Both the global rating scores of the 2 scripts were significant improvement after training (Drug Compliance, p = 0.0409, and Work Overload, p = 0.005). Regarding the training effect of 8 skills, self introduction(p = 0.0005), open question(p = 0.0128), tell-ask-tell(p = 0.0484), respecting(p = 0.0198), and additional information-therapeutic alliance (p = 0.0035)got improved after training. Combining training program and OSCE was effective in this pilot study, and it is worth exploring the persistence of training or other underlying needs for the MG Club volunteers.

並列關鍵字

myasthenia gravis ； counseling skill ； objective structured clinical examination

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