醫病溝通教學的觀念與策略

Teaching Doctor-patient Communication Skills: Concepts and Strategies

謝茉莉 ； 洪利穎

《人文社會與醫療學刊》 1期 (2014/04) Pp. 37-56

https://doi.org/10.6279/JHSSM.2014.1(1).02

摘要

醫生缺乏溝通技巧，經常是病患對於健康照顧不滿意的主因，更是引起病患抱怨和訴訟的可能動機。近年來的醫學教育逐漸將醫病溝通視為核心價值之一，也認為醫病溝通能力，是病人區分醫生是否優質的重要指標。但是，如何有效教導醫病溝通課程，引起學生的學習興趣，並能將所學運用於臨床現場之中，是醫學教育者常會面臨的挑戰。本文試圖從質性研究的結果，來討論醫病溝通教學的內涵與策略。首先說明影響醫病溝通良瓠的主要因素，包括「醫學生的個人因素」、「醫病溝通中支持性與干擾性的語言行為」、及「其它干擾性因素」。其次，闡述Vygotsky「鷹架理論」應用於醫病溝通教學的基礎。「鷹架理論」強調，支持性學習鷹架的提供，有助於高層次的心理活動及知識系統的建構，不僅提供學生價值澄清的機會，更能幫助學習者內化學習，建構醫病溝通的價值系統。最後，本文融合「角色扮演」的教學模式，提出教導醫病溝通的五個基本策略：「事前準備」、「示範」、「角色扮演」、「回饋評鑑與省思」、「經驗共享與類化」。並以醫病溝通課程的教學設計為例加以說明。綜上所述，本文以鷹架理論為基礎，結合角色扮演，針對醫病溝通的觀念及教學，提出符合學習心理的教學實務策略，企盼能做為醫學教育者在教授相關課程時的參考，提升醫學教育的品質。

關鍵字

醫病溝通 ； 醫學教育 ； 鷹架理論 ； 角色扮演

並列摘要

Doctors' lack of communication skills has been one of the major dissatisfactory issues for doctor-patients relationships and healthcare complaints. Nowadays, communication skill has become a core competency for medical education. However, it has been challenging for medical educators to develop and implement teaching programs in effective and interesting ways.The purpose of this article is to discuss the content and strategies for teaching doctor-patient communication from a theoretical and practical perspective. Factors which affect therapeutic communication, such as medical students' backgrounds, along with supportive and non-supportive behaviors, are discussed. Next, the article illustrates the possibility of applying Vygotsky's scaffolding theory into teaching activities, along with an approach for doing so. Vygotsky's theory proposes that it is necessary to provide value clarification and process for internalization for students to integrate their previous experiences and new learning. The conclusion of this article will provide five basic role-play strategies as teaching methods, including preparations, modeling, role-play, feedback and reflection, and experience-sharing.This article integrates scaffolding theory and the role-play approach for constructing doctor-patient communication courses in medical school. Hopefully, it will serve as a reference and teaching guideline for teachers and researchers in the field of medical teaching, and enhance the quality of medical education.

並列關鍵字

doctor-patient communication ； medical education ； scaffolding theory ； role play

參考文獻

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