叙事医学在临床实习中的应用及效果评价研究：以胸外科为例

目的 探讨叙事医学教学干预对胸外科临床实习学生的学习成绩和共情能力中的影响。方法 将重庆医科大学临床医学“5+3”一体化专业74名在胸外科实习学生分为观察组（37人）和对照组（37人）。对照组采用传统教学,观察组在传统教学基础上增加叙事医学教学。比较两组学生的出科考核成绩、人文关怀水平、共情水平、医患关系处理能力、教学满意度、学科兴趣和毕业工作意向。采用SPSS 21.0进行t检验和卡方检验。结果 在专业理论成绩观察组（85.16±10.04）,对照组（79.73±8.27）]、操作技能成绩观察组（85.32±8.77）,对照组（79.70±7.56）]、人文关怀水平观察组（3.78±0.95）,对照组（3.24±1.04）]、共情水平量表评分观察组（104.89±12.90）,对照组（96.57±11.00）]、医患沟通技能和职业实践信心、医生患者定位的问卷观察组（52.59±10.15）,对照组（72.59±5.86）]、教学满意度（观察组89.2%,对照组64.8%）、学科兴趣观察组（3.86±1.08）,对照组（3.05±1.12）]和毕业工作意向（观察组29.7%,对照组8.1%）上,观察组均优于对照组,差异有统计学意义。结论 在临床实习带教中引入叙事医学,可以提高教学效果、学生的共情能力和教学满意度。

Application and effectiveness of narrative medicine in clinical internship: with department of thoracic surgery as an example

Objective To investigate the effect of narrative medicine teaching on the academic performance and empathy ability of clinical interns in department of thoracic surgery.Methods A total of 74 interns in the department of thoracic surgery, with the "5+3" integration major of clinical medicine in Chongqing Medical University, were divided into observation group and control group, with 37 interns in each group. The interns in the control group received traditional teaching, and those in the observation group received narrative medicine teaching in addition to traditional teaching. The two groups were compared in terms of department examination score, level of humanistic concern, empathy level, ability to handle doctor-patient relationship, degree of satisfaction with teaching, discipline interest, and job intention after graduation. SPSS 21.0 was used to perform the t-test and chi-square test.Results Compared with the control group, the observation group had significantly better theoretical score (85.16±10.04) vs. (79.73±8.27)], operational skill score (85.32±8.77) vs. (79.70±7.56)], level of humanistic concern (3.78±0.95) vs. (3.24±1.04)], empathy scale score (104.89±12.90) vs. (96.57±11.00)], results of the questionnaire on doctor-patient communication skills, confidence in professional practice, and doctor-patient orientation (52.59±10.15) vs. (72.59±5.86)], degree of satisfaction with teaching (89.2% vs. 64.8% in the control group), discipline interest (3.86±1.08) vs. (3.05±1.12)], and job intention after graduation (29.7% vs. 8.1%).Conclusion Narrative medicine introduced into clinical practice teaching can improve the effectiveness of teaching, the empathy ability of students, and the degree of satisfaction with teaching.