目的 探讨在肾内科住院医师规范化培训中进行医患沟通(doctor-patient communication,DPC)技能培训的效果。方法 选取2018年1月至2018年12月在上海交通大学附属第一人民医院肾内科参加住院医师规范化培训的49名住院医师为研究对象,在为期一个月的肾内科住院医师规范化培训中增加5个学时的DPC技能教育讲座,并进行实时实践指导。培训前后采用SEGUE量表对住院医师的DPC能力进行评估,采用住院患者对医疗服务满意度的调查表进行患者满意度评价。结果 SEGUE评分结果显示,进行了理论实践相结合的住院医师DPC技能培训后,住院医师的SEGUE总评分有所提高[(21.90±2.00)分比(17.52±1.90)分],其差异具有统计学意义(t=-10.98, P<0.01)。患者或陪护家属评价结果显示,接受DPC培训后的住院医师患者满意度高于既往住院医师水平[(24.42±1.27)分比(19.84±2.49)分],其差异具有统计学意义(t=11.34, P<0.01)。结论 在住院医师规范化培训中进行肾内科DPC技能培训,有助于住院医师树立明确的道德意识、形成个人的医德观和处理医患关系的原则、提高DPC能力、建立和谐的医患关系。
Objective This study aimed to evaluate the effectiveness of a doctor-patient communication (DPC) training program designed for standard training of resident in nephrology department. Methods A total of 49 residents who participated in the resident standardized training in Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and December 2018 were recruited. Residents were recruited to participate in a doctor-patient communication skills training program. The residents were evaluated by the “SEGUE Scale” (Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter; SEGUE) before and after the program. The patients' satisfaction was evaluated by the “Questionnaire on Satisfaction of Hospitalized Patients with Medical Services”. Results SEGUE scale evaluation results showed that the total score of SEGUE increased after the DPC skill training[(21.90±2.00) vs (17.52±1.90), t=-10.98,P<0.01)]. Patient satisfaction survey showed that patients' satisfaction was improved after the DPC training program[(24.42±1.27 )vs (19.84±2.49), t=11.34, P<0.01]. Conclusions This training program of doctor-patient communication skills in nephrology Department improved DPC competency of residents and effectively enhanced the levels of patients' satisfaction.
[1] Silverman J, Kurtz S, Draper J. Skills forcommunicating with patients[M]. 3rd ed. Milton Keynes: Radcliffe Publishing Limited, 2013:6-7.
[2]Core Committee, Institute for International Medical Education. Global minimum essential requirements in medical education[J].Med Teach, 2002, 24(2):130-135.DOI: 10.1080/01421590220120731.
[3]Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey[J]. Lancet, 2012, 379(9818): 815-822. DOI: 10.1016/S0140-6736(12)60033-6.
[4]GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet,2020, 395(10225):709-733.DOI: 10.1016/S0140-6736(20)30045-3.
[5] Makoul G. The SEGUE framework for teaching and assessing communication skills[J]. Patient Educ Couns, 2001,45(1):23-34. DOI: 10.1016/s0738-3991(01)00136-7.
[6]申丽君, 孙刚. 基于SEGUE量表的医生医患沟通技能评价研究[J].中国全科医学,2017(16):1998-2002. DOI: 10.3969/j.issn.1007-9572.2017.16.019.
[7]Schirmer JM, Mauksch L, Lang F, et al. Assessing communication competence: a review of current tools[J]. Fam Med, 2005, 37(3):184-192.
[8] 杨健, 宁玉文, 殷进功. 基于SEGUE量表的医学生医患沟通能力评价[J]. 医学教育研究与实践, 2018, 26(3):419-421.DOI:10.13555/j.cnki.c.m.e.2018.03.017.
[9]Kurtz S, Silverman J, Benson J, et al. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides[J]. Acad Med, 2003,78(8):802-809. DOI: 10.1097/00001888-200308000-00011.
[10]Koncicki HM, Schell JO. Communication skills and decision making for elderly patients with advanced kidney disease: a guide for nephrologists[J]. Am J Kidney Dis, 2016,67(4):688-695. DOI: 10.1053/j.ajkd.2015.09.032.
[11]国家卫生计生委, 中央编办, 国家发展改革委, 等. 关于建立住院医师规范化培训制度的指导意见[EB/OL]. [2013-12-31]. http://www.gov.cn/gzdt/2014-01/17/content_2569096.htm.
[12] Yaffe K, Ackerson L, Tamura MK, et al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study[J]. J Am Geriatr Soc, 2010, 58 (2):338-345.DOI: 10.1111/j.1532-5415.2009.02670.x.
[13]Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common[J]. Neurology, 2006,67(2):216-223. DOI: 10.1212/01.wnl.0000225182.15532.40.
[14]Janosevic D, Wang AX, Wish JB. Difficult patient behavior in dialysis facilities[J]. Blood Purif, 2019,47(1-3):254-258. DOI: 10.1159/000494592.
[15] Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer[J]. Oncologist, 2000, 5(4):302-311. DOI: 10.1634/theoncologist.5-4-302.
[16]Bernacki RE, Block SD, American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices[J]. JAMA Intern Med, 2014,174(12):1994-2003. DOI: 10.1001/jamainternmed.2014.5271.
