医学生临床实习过程中医患沟通能力的培养

在临床实习中,医患沟通能力的培养至关重要.本文首先从人文素质和专业素质两方面分析医学实习生在医患沟通能力方面存在的问题;再从现代医学模式和新型医患关系的要求、当今医疗纠纷的主要根源及作为一个医生的专业要求阐述了医学生在临床实习过程中加强医患沟通能力培养的重要性和必要性;最后就如何在实习过程中培养医患沟通能力教学探讨.     

影响医学生临床实习质量的因素及对策

医学生的临床实习质量目前面临着学生就业因素、医学实习生医疗活动的合法性问题、学生医患沟通能力的影响,通过加强师生之间的交流与沟通、加强法律知识和人文知识的学习、提高医学生的医患沟通能力的培养,可以提高医学生的临床实习质量.     

基于计划行为理论的医学实习生医患沟通行为影响因素分析

目的通过建立基于计划行为理论的医学实习生医患沟通行为影响因素理论模型,对影响医学实习生医患沟通行为的因素进行探究。方法对在重庆市3所三级甲等医院实习的322名医学本科生进行问卷调查,运用回归分析法对数据进行分析。结果医患沟通结果的利他性(β=0.126,P<0.05)、医生的职责要求(β=0.140,P<0.05)、医学生所处环境的影响(β=0.263,P<0.05)和他人评价(β=0.337,P<0.05)对医学实习生的医患沟通行为的意向有显著影响。结论要继续强化医学生对医患沟通认知的教育和医患沟通能力的培养。     

加强医学临床实习生人文素质教育对医患沟通的影响

良好的医患沟通可有效减少医患纠纷的发生。临床医学实习生在医患沟通中因为人文素质的缺乏,欠缺良好的医患沟通能力,表现在注重疾病交流,忽视人的交流,缺乏沟通技巧及自信,法律意识淡薄等。加强医学实习生的人文素质教育,能树立医学实习生良好的道德品质、高尚的医德医风以及健全的法律意识,增强其自信心及沟通技巧,从而提高其医患沟通能力。     

临床实习医师医患沟通技能培养

在临床实习阶段加强实习生沟通技能的培养,对营造和谐的医患关系至关重要。但我国医学生医患沟通技能培养并未受到全面重视。本文从分析医患沟通技能教育现状人手,结合教学中总结的经验进行分析和探讨,提出加强临床实习医师医患沟通技能培养的对策和建议。     

加强医学临床实习生人文素质教育对医患沟通的影响

良好的医患沟通可有效减少医患纠纷的发生。临床医学实习生在医患沟通中因为人文素质的缺乏,欠缺良好的医惠沟通能力,表现在注重疾病交流,忽视人的交流,缺乏沟通技巧及自信,法律意识淡薄等。加强医学实习生的人文素质教育,能树立医学实习生良好的道德品质、高尚的医德医风以及健全的法律意识,增强其自信心及沟通技巧,从而提高其医患沟通能力。     

新医改背景下实习生医患沟通能力的培养

新医改对构建健康和谐的医患关系提出了具体要求,良好的医患沟通是医疗行为的重要组成部分.目前,由于医学生医患沟通技能培训尚未达到足够重视,在临床实习阶段加强实习生医患沟通能力的培养,对营造和谐的医患关系、提高医学生素质有着至关重要的意义.     

实习生医疗安全管理的探讨

临床实习生医疗安全是教学医院管理中的重点和难点.探讨加强实习生医疗安全管理的途径与方法,完善实习生医疗安全管理机制,将医疗安全教育贯穿于临床课程教学之中,抓好进入实习前的培训,注重临床能力的培养,与医德医风教育相结合,发挥临床老师的带教作用,提高医患沟通技巧,重视医疗文件的规范书写,克服实习后期倦怠心理,强化临床实习生自我医疗安全管理意识,是教学医院实现医疗安全管理的有效策略.     

临床典型案例式教学在实习生带教中的应用

目的：探讨临床典型案例式教学在实习生带教中应用的效果。方法：选取我校同一附属医院前后2年在胃肠外科实习的80名学生,实验组在常规临床教学基础上采用典型案例式教学,对照组采用常规临床教学。比较两组学生临床操作技能、临床医学思维能力、临床医患沟通能力以及对教学的满意度。结果：实验组临床操作技能、临床思维能力考核成绩、临床医患沟通能力考核成绩和学生对教学满意度均高于对照组,差异有统计学意义（P＜0.05）。结论：临床典型案例式教学,有助于进一步提高胃肠外科实习生的临床操作技能,建立临床医学思维能力,提升医患沟通技巧以及对临床教学满意度,有助于医学生向临床医生转变。     

加强口腔医学生与患者沟通的能力

口腔临床医学是一门理论性和实践性都很强的学科。良好的医患沟通能够减少医疗纠纷,有利于实习生的临床操作,是口腔治疗成功的保障,也是现代医学模式的要求。带教老师除了需要培养实习生掌握一定的临床理论和操作技能,还要提高他们与患者沟通的能力。帮助他们顺利完成从实习生到医生的过渡。     

Evaluation of an interview training course for general practitioners

This article describes the evaluation of an experimental training in doctor-patient communication for general practitioners. The training was based on Rogerian theory and accommodated to the specific situation of the general practitioner. The main concept of this theory is the notion of 'unconditional positive regard'. It was expected that doctors would change their communication behaviour and that as a result patients would talk more about their psychosocial problems. The training was restricted to the diagnostic process, no therapeutic interventions were taught. The effects of this training have been measured by comparing video-tapes of live doctor-patient consultations, before and 3 months after the training. The most important result of this evaluation study turned out to be the change of the doctor's behaviour in the expected direction, but surprisingly the outcome of the consultation did not change at all: the doctors were empathically listening, but the patients did not talk more about their problems. Creating room for patients is not sufficient to induce them to discuss their personal problems with their doctors. Perhaps they do not feel like discussing their personal problems with them at all.     

The Calgary—Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes

Effective communication between doctor and patient is a core clinical skill. It is increasingly recognized that it should and can be taught with the same rigour as other basic medical sciences. To validate this teaching, it is important to define the content of communication training programmes by stating clearly what is to be learnt. We therefore describe a practical teaching tool, the Calgary-Cambridge Referenced Observation Guides, that delineates and structures the skills which aid doctor-patient communication. We provide detailed references to substantiate the research and theoretical basis of these individual skills. The guides form the foundation of a sound communication curriculum and are offered as a starting point for programme directors, facilitators and learners at all levels.
We describe how these guides can also be used on an everyday basis to help facilitators teach and students learn within the experiential methodology that has been shown to be central to communication training. The learner-centred and opportunistic approach used in communication teaching makes it difficult for learners to piece together their evolving understanding of communication. The guides give practical help in countering this problem by providing:

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  an easily accessible aide-mémoire ;
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  a recording instrument that makes feedback more systematic; and
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  an overall conceptual framework within which to organize the numerous skills that are discovered one by one as the communication curriculum unfolds.

     

The views of senior students and young doctors of their training in a skills laboratory

The study was carried out in the Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates (UAE) University, UAE, where a skills laboratory was set up in 1988 to train medical students in clinical skills before they use such skills on patients. The students learn clinical skills using simulated patients, models and mannequins. The training starts in the first year of the 6-year undergraduate curriculum and continues until the end of the fourth year, after which students rotate through the clinical specialties. This study sought to identify: (1) the views of senior clerks (sixth year) and interns (first postgraduate year) regarding the clinical skills training in the skills laboratory (SKL) during the early years of the medical curriculum; (2) the differences in views between senior clerks and interns; (3) the differences in views between women and men students. Students' views about communication, interviewing, physical examination, therapeutic, diagnostic and laboratory skills were investigated. The results indicated that prior training in clinical skills was helpful to the senior clerks and the interns. Statistically significant differences in opinion were noted between the senior clerks and the interns, the interns being more positive about the usefulness of the SKL training compared with learning clinical skills directly on patients. There was no difference between men and women students except that women students were not comfortable with allowing their peers to examine any part of their bodies. The findings of the study have direct implications for the SKL programme.     

谈医学实习生临床带教中的问题

本文就医学实习生临床带教工作中,带教方和实习生方面存在的一些问题进行分析。从建立健全教学管理体制,试行实习生导师制,加强对带教导师的培养教育,实现带教方式多样化;注重人文素质教育,学习沟通技巧和艺术;加强风险意识教育,严格基本技能训练,调动实习积极性等方面提出相应的解决对策。     

PBL在临床医生医患沟通技巧培训中的应用

目的探讨以问题为基础的教学法在临床医生沟通技巧培训中的应用。方法对某医院150名临床医生采用PBL教学方法,充分调动医生们的学习积极性,结合头脑风暴法引导医生们提炼出医患沟通中的关键要素和临床沟通技巧,并请某患者（已愈）现场参与,模拟演练。结果经过沟通技巧培训,医生们医患沟通意识、医患沟通能力和沟通技巧得到明显提升。结论 PBL教学培训法用于临床医生医患沟通技巧培训效果较好,有条件的医院可以将其推广应用。     

口腔科实习生岗前培训探讨

为保证口腔实习生能够顺利进入医院进行实习,最大限度地保证诊疗安全,避免医疗纠纷,在口腔实习生进行实习前,对其进行爱院爱科教育、规章制度教育、医疗安全教育、医德医风教育、组长选拔管理、实习目标制定、口腔三基培训、电脑操作培训、病历书写培训、院感知识培训、医患沟通培训、礼仪形象培训、应急能力培养等岗前培训,使口腔实习生实现从学校到医院,从课堂到病房,从学生到医生,从理论到实践的转变,减少和避免了直接进入临床后出现的问题,确保了临床实习任务的顺利完成,提高了临床实习质量。     

实习医师临床操作技能调查

目的：了解实习生临床技能水平,为医学人才培养方案的制定提供理论依据。方法通过问卷调查,对203名本科五年制实习生临床技能操作的掌握情况进行调查,并根据实习结束后的临床技能操作考核成绩作为评判标准。结果①6所教学医院实习生技能掌握情况良好率为16．75％,临床教学实践和实习效果不容乐观。②在203名实习生中,模拟人练习组考核优秀率为56．1％,未接受模拟人练习组优秀率为41．3％,差别有统计学意义（χ2＝4．281,P ＜0．05）。理论培训组考核优秀率为61．8％,未接受理论培训组优秀率为41．9％,差别有统计学意义（χ2＝6．387,P ＜0．05）。③在进行操作时会事先与患者进行充分沟通的实习生中57．5％可以得到患者的充分配合。在未沟通组中仅有40．6％的实习生可以得到患者的配合,差别有统计学意义（χ2＝5．199,P ＜0．05）。结论实习生在临床技能操作中操作机会少、教学培训少等问题不同程度存在,严重影响临床教学质量。建议采用技能培训、加大建设力度、制定科学的实习方案等方法提高临床教学质量。     

Physician communication skills training: a review of theoretical backgrounds,objectives and skills

CONTEXT: Significant shortcomings have been noted in the literature in communication skills training for practising doctors. Given the importance of competent communication to the doctor-patient relationship and health care in general, these shortcomings should be addressed in future research. OBJECTIVE: Research into physician communication skills training is examined with respect to the communication objectives and behaviours that are addressed. METHODS: A Medline search of literature from 1990 to the present was conducted. RESULTS: A total of 26 studies of doctor communication skills training were found. The majority of studies included insufficient information about the communication behaviours taught to participants. In several studies, there was a mismatch between stated behaviours and instruments or procedures used to assess them. CONCLUSION: Three recommendations are suggested. Firstly, future researchers should take greater care in matching assessment instruments with stated communication skills. Secondly, researchers should provide and use a theoretical framework for selecting communication skills to address in interventions, and thirdly, the timing of communication skills within the interview context should be part of the instruction in interventions.