反思性写作服务于全科医学生叙事医学能力培养实践

目的 为改善全科医学生叙事医学和精神卫生服务能力,满足社区医疗和康复医疗对合格全科医生的迫切需求,引入反思性写作探讨服务于全科医学生同理心和叙事治疗胜任力培养的实践做法。 方法 研究采取内容分析法和主题分析法定性分析全科医学生叙事医学能力培养。选取西安医学院第一附属医院(三级甲等医院)带教医生、住院患者、全科医学专业实习生各60名参与反思性书写。 结果 带教医生、全科医学实习生和住院患者在医患共情、反思、医患沟通三方面达成共识。医生和患者都关注疾病叙事;医生更多关注自身业务能力、职业精神、自我健康和心理弹性管理;患者关注医生言行、家庭支持、医院人文关怀与服务;医学生关注业务能力、职业精神、专业成长和了解患者。研究构建了服务于全科医学生叙事医学能力培养目标下的四方医学叙事视界融合模型。 结论 医学的本质是全人身心照护。全科医学生需树立以患者为中心的理念,加强患者了解、注重医患沟通、强化医患共情和职业自省意识、不断提升业务能力、优化职业精神、强化自我健康和心理弹性管理,树立医病医身医心的临床思维,不断研习叙事疗法,践行人文关怀,强健医疗实践。全科医学生依托反思性书写提高了叙事医学能力,对于重构和修复医患关系、强固医患共同体、改善社区居民身心照护和个性化医疗有积极意义。 

GP undergraduates'narrative competency development via reflective writing

Objective To develop GP majors' narrative competency and mental health service and foster narrative therapy and empathetic care in the community to meet the increasing need of primary care and rehabilitation therapy. Methods Qualitatively, we adopted content analysis and thematic analysis to explore general GP majors' narrative competency cultivation. Totally, 60 GP clerkship undergraduates, 60 hospitalized patients and 60 doctors from the teaching hospital named the1st Affiliated Hospital of Xi'an Medical University co-participated in reflective writing concerning their clinical training, medical treatment and doctoring experiences respectively. Results Doctors, GP undergraduates and patients all value such themes as self-reflection, doctor-patient empathy and communication. Both doctors and patients value illness narration. Comparatively, doctors attach greater importance to clinical competency, self-health and resilience, patients to doctors' behavior, family support, hospital humanistic care and service, GP undergraduates to professional competency and development and getting to know patients. A narrative model was constructed to develop GP majors' narrative competency, namely, the combination of narration from doctors, patients, family and hospital. Significantly, doctors, GP clerkship majors and patients all value such factors as doctor-patient empathy and communication and reflection. Conclusions Undoubtedly, the essence of medicine is the care of body and mind. GP majors should develop collaborative patient-centered care, get to know patients and improve doctor-patient communication and empathetic competency and self-reflection, skills, self-health management and resilience, ultimately clinically competent for not handling disease, but also take good care of both body and mind. GP majors are expected to develop their insight into narrative therapy and nurture humanism to better primary care in the community. Narrative competency cultivation of clerkship GPs by reflective writing plays an important role in fixing doctor-patient relationship, rebuilding doctor-patient community and improving body and mind care and personalizing and customizing the patients care.