关于加强儿科学专业医学生医患沟通能力培养的研究

如何在现有医疗纠纷高发的形势下尽力做好医患和谐，医患沟通重新被置于重要地位。对于儿童这个特殊的群体，语言交流的对象主要是患者父母及家属，需要家长配合教学，而行体格检查时又需取得患儿的合作，因此加强医学生医患沟通能力显得尤为重要。良好的医患沟通能力是医学生成为一名合格医生不可缺少的条件。     

国内解剖学课程设置分析及我院的改革实践

由于高等教育观念的更新,招生规模的扩大及现代教育技术的迅速提高,对传统的解剖学、教学方法形成有力的挑战,为此,我们研究了国外解剖学教学状况,并对国内65所医学院校(含综合性大学内的医学院)临床医学专业(五年制)的解剖学课程设置情况进行了调研,对其资料进行了详细分析。根据分析结合我院实际情况,对我院解剖学课程设置、教学方法进行改革,取得明显效果。     

医学教学中加强对医学生医患沟通能力的培养

医患沟通教育是当代医学生的必修课,良好的医患沟通是降低医患纠纷的重要手段。培养适合当代社会需求、具有良好沟通能力的高素质医学人才是医学院校的根本目标。本文阐述了医学教育中加强医患沟通能力培养的重要性和必要性,提出了培养医学生医患沟通能力的建议,为减少医患纠纷,构建和谐医患关系打下了良好基础。     

二年级与四年级医学生医学心理学成绩及其课程设置的调查

二年级与四年级医学生医学心理学成绩及其课程设置的调查刘少文，姚树桥湖南医科大学医学心理学研究中心随着医学模式由生物医学模式向生物、心理、社会医学模式转变，人们愈来愈认识到心理因素和社会因素对人体健康和疾病影响的重要性［１，２］。医学心理学已成为现代医...     

医学生在外科实习中存在的问题及对策

外科学是一门实践性很强的学科，学生除了要掌握基本知识与基本理论外，还要掌握较多的基本技能，是外科教学的一个重要环节。随着医疗体制改革步伐的不断加快，作为医学教育关键环节的临床实习教学也进行了深入的改革，但实习效果仍令人担忧。本文就医学生在外科实习中存在的问题进行了认真分析，并总结出一些经验。     

基于技能大赛提高医学生临床技能的培养探讨

技能教学是高等医学院校教学的基础。目前一些高等医学院校在技能比赛中虽获得了一定的成绩。但是,技能比赛在提升教学质量方面还需加强。本文就当前高等医学院临床技能教育情况,分析了临床技能竞赛的重要性,同时探究了以技能比赛促进技能教学的方式。     

临床情景剧在医患沟通培训及考核中的应用

临床人文医患沟通是医务工作者的一项基本能力,与医疗技术同样重要。近年来针对医学生临床沟通技能的教学也愈发受到重视。然而作为一项实践技能,其教学和考核有不同于理论课的特殊性,难度较大。北京协和医学院心理医学科,基于心理剧和角色理论,发展出一种新的沟通教学和评价方法——临床情景剧考试方法。该方法将医学生投入不同角色去共情其内心感受与冲突,主动运用医疗技术以外的人文沟通技术解决临床难题,并从旁观者的分享与点评进一步理解情境和思考其他可能的解决方法。     

在人体解剖教学中培养医学生语言沟通能力的探讨与实践

在现代医学教育模式下,培养医学生语言沟通能力是医学教育的基本要求,也是建立和谐医患关系的基础,但目前该能力的培养仍未受足够重视。多年来,我们一直在人体解剖学教学各环节中采用5种举措积极培养学生的语言沟通能力,并取得了初步效果。     

妇产科临床实践中的医患沟通要点

<正>妇产科的医疗活动具有高风险性,医疗纠纷发生率近年呈上升趋势。已知超过95%的医疗官司属于医疗纠纷,其中80%直接缘于医患双方沟通不畅,其余20%虽与医疗技术相关,也与医患沟通欠佳密切相关[1]。世界医学教育联合会《福冈宣言》[2]中指出:     

沟通技能培训在血液净化中心临床教学中的应用

医患沟通是医疗服务中最重要的环节,是患者对医生信任、理解、配合以及顺利完成诊疗计划、保证医疗质量的前提[1].血液净化中心治疗包括血液透析、血液透析滤过、血液灌流、连续性血液净化等,治疗涉及透析机、透析器、透析器复用、抗凝技术等,多数患者需要长期定时治疗.因此血液净化中心医生不仅需要掌握血液净化技术,而且要和患者长期反复接触,沟通技能的培训显得日益重要.我们在临床教学时特别重视医生沟通技能的培养,现将体会报告如下.     

The value of training in communication skills for continuing medical education

Objective

Question arises as to what extent communication skills are considered in continuing medical education (CME).

Methods

Analysis for CME-courses in communication skills in the area of the Chamber of Physicians North Rhine (ÄkNo), Germany. Supply Arm(A): CME events (n = 19,320) certified in 2007 were evaluated. Demand Arm(B): course participation of 850 family physicians in the period 2002-2007 was analyzed (n = 37,724). Tests were calculated to the level 0.05 using Mann-Whitney U-test.

Results

(A) 388 (2.0%) events were concerned with the topic communications. 59.3% involved active cooperation of the participants. 0.5% events devoted more than 50% of their duration to the topic communication. Proportions in the subjects of internal medicine, general medicine and pediatrics amounted to 0.2%. (B) 803 (2.1%) events with a focus on communication were identified. Women took part in significantly more events than men (p < 0.002) and selected more interactive courses.

Conclusion

Content on communication training was small. Increasing experience does not automatically improve communication skills but an extent of deliberate praxis seems to be necessary and must be sought and developed.

Practice implications

Communication skills are still insufficiently provided in CME-courses and should be more directed to focus as treatment strategies and scientifically investigated for outcome improvements.     

Self-guided clinical cases for medical students based on postmortem CT scans of cadavers

In the summer of 2009, we began full body computed tomography (CT) scanning of the pre-embalmed cadavers in the University of Michigan Medical School (UMMS) dissection lab. We theorized that implementing web-based, self-guided clinical cases based on postmortem CT (PMCT) scans would result in increased student appreciation for the clinical relevance of anatomy, increased knowledge of cross-sectional anatomy, and increased ability to identify common pathologies on CT scans. The PMCT scan of each cadaver was produced as a DICOM dataset, and then converted into a Quicktime movie file using Osirix software. Clinical cases were researched and written by the authors, and consist of at least one Quicktime movie of a PMCT scan surrounded by a novel navigation interface. To assess the value of these clinical cases we surveyed medical students at UMMS who are currently using the clinical cases in their coursework. Students felt the clinical cases increased the clinical relevance of anatomy (mean response 7.77/10), increased their confidence finding anatomical structures on CT (7.00/10), and increased their confidence recognizing common pathologies on CT (6.17/10). Students also felt these clinical cases helped them synthesize material from numerous courses into an overall picture of a given disease process (7.01/10). These results support the conclusion that our clinical cases help to show students why the anatomy they are learning is foundational to their other coursework. We would recommend the use of similar clinical cases to any medical school utilizing cadaver dissection as a primary teaching method in anatomy education.     

Development and evaluation of a risk communication curriculum for medical students

Objective

To develop, pilot, and evaluate a curriculum for teaching clinical risk communication skills to medical students.

Methods

A new experience-based curriculum, “Risk Talk,” was developed and piloted over a 1-year period among students at Tufts University School of Medicine. An experimental study of 2nd-year students exposed vs. unexposed to the curriculum was conducted to evaluate the curriculum's efficacy. Primary outcome measures were students’ objective (observed) and subjective (self-reported) risk communication competence; the latter was assessed using an Observed Structured Clinical Examination (OSCE) employing new measures.

Results

Twenty-eight 2nd-year students completed the curriculum, and exhibited significantly greater (p < .001) objective and subjective risk communication competence than a convenience sample of 24 unexposed students. New observational measures of objective competence in risk communication showed promising evidence of reliability and validity. The curriculum was resource-intensive.

Conclusion

The new experience-based clinical risk communication curriculum was efficacious, although resource-intensive. More work is needed to develop the feasibility of curriculum delivery, and to improve the measurement of competence in clinical risk communication.

Practice implications

Risk communication is an important advanced communication skill, and the Risk Talk curriculum provides a model educational intervention and new assessment tools to guide future efforts to teach and evaluate this skill.     

Medical students’ communication skills in clinical education: Results from a cohort study

ObjectiveTo assess students’ communication skills during clinical medical education and at graduation.MethodsWe conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards.Results26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients’ perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated.ConclusionMedical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness.Practice implicationsThe necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students’ communication competencies are firmly achieved at graduation.     

Integrating ultrasound into modern medical curricula

Ultrasonography is widely practiced in many disciplines. It is becoming increasingly important to design well‐structured curricula to introduce imaging to students during medical school. This review aims to analyze the literature for evidence of how ultrasonography has been incorporated into anatomy education in medical school curricula worldwide. A literature search was conducted using multiple databases with the keywords: “Ultrasound OR Ultrasonographic examination*” and “Medical student* OR Undergraduate teaching* OR Medical education*” and “Anatomy* OR Living anatomy* OR Real‐time anatomy.*” This review found that ultrasound curricula vary in stage of implementation, course length, number of sessions offered to students as well as staffing and additional course components. Most courses consisted of didactic lectures supplemented with demonstration sessions and/or hands‐on ultrasound scanning sessions. The stage of course implementation tended to depend on the aim of the course; introductory courses were offered earlier in a student's career. Most courses improved student confidence and exam performance, and more junior students tended to benefit more from learning anatomy with ultrasound guidance rather than learning clinical examination skills. Students tended to prefer smaller groups when learning ultrasound to get more access to using the machines themselves. Ultrasonography is an important skill, which should be taught to medical students early in their careers as it facilitates anatomical education and is clinically relevant, though further objective research required to support the use of ultrasound education as a tool to improve clinical examination skills in medical students. Clin. Anat. 30:452–460, 2017. © 2017 Wiley Periodicals, Inc.     

What parents want from emails with their pediatrician: Implications for teaching communication skills

Objective

Physician–patient email communication is increasing but trainees receive no education on this communication medium. Research eliciting patient preferences about email communication could inform training. Investigators elicited parents’ perspectives on physician–parent email communication and compared parent and faculty assessments of medical students’ emails.

Methods

This mixed methods study explored physician–parent email communication in 5 parent focus groups using qualitative analyses to identify themes. Differences between faculty and parent assessment scores for students’ email responses were calculated using univariate general linear modeling.

Results

Themes that emerged were: (1) Building the Relationship, (2) Clarity of Communication and (3) Expectations. Parents criticized student's statements as condescending. The sum of assessment scores by parents and faculty were moderately correlated (r(44) = .407, P < .01), but parents gave students lower scores on “acknowledges validity/expresses empathy” (P = .01) and higher scores on “provides next steps” (P < .01) and “identifies issues” (P < .01).

Conclusion

Parents place value on students’ abilities to communicate clearly and convey respect and empathy in email. Parent and faculty perspectives on email communication are similar but not the same.

Practice implications

Differences between parental and faculty assessments of medical students’ emails supports the need for the involvement of patients and families in email communication curriculum development.     

A clinical anatomy curriculum for the medical student of the 21st century: Gross anatomy

Human anatomy forms the foundation for clinical medicine: thus its place in the medical school curriculum deserves careful attention. In an attempt to provide guidance to decision-makers involved in clinical anatomy curriculum development at the medical school level, the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) developed this document, which defines the contours of a gross anatomy curriculum leading to the M.D. or D.O. degree. The main body of the document sets forth the anatomical concepts as well as the subject matter a student should master prior to graduation from medical school. The AACA seeks to ensure that all medical students receive thorough training in clinical anatomy and that each student, regardless of the institution attended, will be exposed to a curriculum that will provide a fundamental level of competence required for the practice of medicine. © 1996 Wiley-Liss, Inc.