醫學生修習「醫病關係與溝通技術」課程後之學習成效探討

Effect of Patient-Doctor Communications Curriculum on Medical Student Clinical Performance

蔡詩力(Shih-Li Tsai) ； 楊志偉(Chih-Wei Yang) ； 葉啟娟(Chih-Chuan Yeh) ； 何明蓉(Ming-Jung Ho) ； 吳美環(Mei-Hwan Wu) ； 賴鴻緒(Hong-Shiee Lai) ； 張上淳(Shan-Chwen Chang) ； 倪衍玄(Yen-Hsuan Ni)

《Journal of Medical Education》 14卷1期 (2010/03) Pp. 23-35

https://doi.org/10.6145/jme.201003_14(1).0003

摘要

Aim: Patient-physician communication is an essential core clinical competency that is indispensable to medical education. A literature review suggests that an integrated longitudinal design is the best way to develop this curriculum. The aim of this study is to determine the effectiveness of a pilot integrated communication curriculum for medical students. Methods: A communication curriculum was developed taking into consideration the local cultures. Forty-nine medical students who were undertaking their 6-week pediatric internship training between April 2008 and June 2008 were recruited to participate in this study. Students were assigned to either the intervention group or the control group. The twenty-five students in the intervention group received a four-hour pilot course in the first week of their 6-week training. The twenty-four students in the control group did not take the pilot course. The clinical communication skills of all 49 students were evaluated by the clinical faculty during the group objective structured clinical examinations (GOSCEs) at the end of pediatric internship. Results: Students exposed to the intervention performed significantly better than those in the control group in terms of their overall GOSCE results (85% vs. 76%; 9% difference; 95% Confidence interval [CI]: 5.5%~12.4%; p＜0.005). The major items in the overall results that showed significant differences included the areas of open-ended questions (13% difference, 95% CI:7.6%~18.6%; p＜0.005), active listening without interrupting the patient (9.8% difference, 95% CI:4.2%~15.4%; p＜0.005), avoiding using jargon (13% difference, 95% CI:7.6%~18.6%; p＜0.005) and organization/time management (10.6% difference, 95% CI:4.2%~16.8%; p＜0.005). Conclusion: Clinical communication skills can be taught and learned. A communication curriculum based on a locally established educational model should significantly improve the seventh-grade students' overall communications competence.

關鍵字

醫病溝通 ； 整合性縱貫式課程 ； 標準化病人 ； 臨床能力

並列摘要

Aim: Patient-physician communication is an essential core clinical competency that is indispensable to medical education. A literature review suggests that an integrated longitudinal design is the best way to develop this curriculum. The aim of this study is to determine the effectiveness of a pilot integrated communication curriculum for medical students. Methods: A communication curriculum was developed taking into consideration the local cultures. Forty-nine medical students who were undertaking their 6-week pediatric internship training between April 2008 and June 2008 were recruited to participate in this study. Students were assigned to either the intervention group or the control group. The twenty-five students in the intervention group received a four-hour pilot course in the first week of their 6-week training. The twenty-four students in the control group did not take the pilot course. The clinical communication skills of all 49 students were evaluated by the clinical faculty during the group objective structured clinical examinations (GOSCEs) at the end of pediatric internship. Results: Students exposed to the intervention performed significantly better than those in the control group in terms of their overall GOSCE results (85% vs. 76%; 9% difference; 95% Confidence interval [CI]: 5.5%~12.4%; p＜0.005). The major items in the overall results that showed significant differences included the areas of open-ended questions (13% difference, 95% CI:7.6%~18.6%; p＜0.005), active listening without interrupting the patient (9.8% difference, 95% CI:4.2%~15.4%; p＜0.005), avoiding using jargon (13% difference, 95% CI:7.6%~18.6%; p＜0.005) and organization/time management (10.6% difference, 95% CI:4.2%~16.8%; p＜0.005). Conclusion: Clinical communication skills can be taught and learned. A communication curriculum based on a locally established educational model should significantly improve the seventh-grade students' overall communications competence.

並列關鍵字

patient-physician communication ； integrated longitudinal curriculum ； standardized patient ； clinical competency

參考文獻

Tsai, S.L.、Yang, C.W.、Yeh, C.C.(2007)。The recruitment and training of standardized patients at National Taiwan University Hospital。J Taiwan Med Educ。11，174-181。

Aspegren, K.(1999).Teaching and learning communication skills in medicine: a review with quality grading of articles. Best Evidence in Medical Education Guide No. 2.Med Teach.21,563-570.

Association of American Medical Colleges(1999).Contemporary Issues in Medicine: Communication in Medicine.Washington, DC:Association of American Medical Colleges.

Association of American Medical Colleges(1999).Medical School Objectives Project, Report III. Contemporary Issues in Medicine: Communication in Medicine.Washington, DC:Association of American Medical Colleges.

Barmeyer, C.I.(2004).Learning styles and their impact on cross-cultural training: an international comparison in France, Germany and Quebec.Int J Intercult Relat.28,577-594.