目的 探讨共情训练对医学生同理心及其情绪症状的改善效果,为进一步改进医患沟通实践教学提供实证依据。方法 选择某医学院2012级和2013级八年制临床医学专业三年级64名学生为研究对象。采用试验对照方法,按照不同级次将64名学生分为试验组(2012级)和对照组(2013级),试验组34名学生,对照组30名学生。试验组学生接受包括6学时共情训练在内的常规课程教学,对照组学生接受没有包括共情训练的常规课程教学。采用人际反应指针问卷和流行病学调查中心抑郁量表,分别于教学前和教学后1周评估两组学生的共情能力、抑郁症状和积极情绪。结果 试验组学生除年龄稍大于对照组学生外,两组学生性别、共情各项指标、抑郁症状、积极情绪评分比较,其组间差异均无统计学意义(均P>0.05);两组学生教学前后共情各项指标、抑郁症状、积极情绪评分比较,其组内差异均无统计学意义(均P>0.05);试验组男生共情训练后的积极情绪评分显著高于训练前评分[训练前(8.23±2.72)分,训练后(8.89±2.72)分,t=-2.126,P=0.039],试验组女生共情训练后的观点采择因子评分显著高于训练前评分[训练前(11.26±2.91)分,训练后(12.48±4.05)分,t=-2.634,P=0.013],其差异均具有统计学意义;对照组男生和女生教学前后共情各项指标、抑郁症状、积极情绪评分比较,其差异均无统计学意义(均P>0.05)。结论 共情训练对医学女生观点采择能力的提高和医学男生自身情绪状况的改善有一定效果,有必要继续尝试在更大样本中进行更长时间的共情训练效果的研究。
Objective To evaluate outcomes of empathy training in medical students, and to provide empirical evidence to the comprehensive training of doctor-patient communication skill. Methods A parallel group controlled trial was implemented in this study. Participants included 64 junior students in eight-year- program. They were assigned to be intervention group (n=34) or control group (n=30). In addition to the traditional teaching as that in control group, the intervention group received six-hour empathy training. During the study period, the two groups received equal number of classes. Interpersonal Reactivity Index (IRI) and Center for Epidemiological Survey Depression Scale (CES-D) were adopted to evaluate empathy (perspective taking, empathy concern et al), depressive symptoms and positive emotion of medical students respectively before and one week after the training. Results Except that participants in intervention group are slightly older than that in the control group, there is no statistically significant difference in gender, empathy, depressive symptoms and positive emotion scores between the two groups (all P>0.05); There is no statistically significant difference in empathy, depressive symptoms, and positive emotion scores between baseline and one week after training in intervention group or control group (all P>0.05); Male participants receiving empathy training had a significantly increase in positive emotion score as comparing to the baseline (baseline: 8.23±2.72, post intervention: 8.89±2.72, t=-2.126, P=0.039). Female participants receiving empathy training had a significantly increase in perspective taking score as comparing to (before training: 11.26±2.91, after training: 12.48±4.05, t=-2.634, P=0.013); There is no statistically significant difference in male or female participants in control group in the field of perspective taking, empathy concern, depressive symptoms, and positive emotion scores (all P>0.05). Conclusions The empathy training does have effect on the improvement of perspective taking, emotional state of medical students. However, further research is still needed for longer observation and larger sample size.
[1] Quince T, Thiemann P, Benson J. Undergraduate medical students' empathy: current perspectives[J].Adv Med Educ Prac,2016(7):443-455.DOI:10.2147/ amep.S76800.
[2] Hojat M, Gonnella JS, Mangione S, et a1. Empathy in medical students as related to academic performance, clinical competence and gender[J].Med Educ,2002,36(6):522-527.DOI:10.1046/j.1365-2923.2002.01234.x.
[3] Hojat M. Empathy in health professions education and patient care[M].New York: Springer International,2016.
[4] Murinson BB, Aqarwal AK, Haythornthwaite JA, et al. Cognitive expertise, emotional development and reflective capacity: clinical skills for improved pain care[J].J Pain,2008,9(11):975-983.DOI:10.1016/j.jpain.2008.07.010.
[5] 李淑静.移情偏好与医患沟通[J].医学与哲学,2014,35(1A):51-53,57.
[6] Kelm Z, Womer J, Walter JK, et al. Interventions to cultivate physician empathy: a systematic review[J].BMC Medical Education,2014,14(1):219.DOI: 10.1186/1472-6920-14-219.
[7] Batt-Rawden SA, Chisolm MS, Anton B, et al. Teaching empathy to medical students: an updated, systematic review[J].Acad Med,2013,88(8):1171-1177. DOI:10.1097/acm.0b013e318299f3e3.
[8] Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care[J].BMC Medical Ethics,2016,17(1):8.DOI: 10.1186/s12910-016-0091-7.
[9] 黄正接,尤俊,谢永丹,等.同理心在医学生临床实习教学中的实践与成效[J].中华医学教育杂志,2013,33(4):590-593.DOI:10.3760/cma.j.issn.1673-677X.2013.04.038.
[10] 张舒,刘汉龙,刘惠军,等.关于医学生同理心的实证研究[J].中国医学伦理学,2014, 27(4):514-517.
[11] 邓玲,蒋凤艳,贾冰,等.当代医学生同理心特点及培养策略研究[J].中国高等医学教育,2015(6):35-36.DOI:10.3969/j.issn.1002-1701.2015.06.018.
[12] 郑亚楠,龚茜.未实习医学生同理心及其影响因素调查[J].现代预防医学,2018, 45(4):679-682.
[13] 姜恬,宛小燕,刘元元,等.长学制医学生同理心现状调查及影响因素初探[J].现代预防医学,2015,42(21):4030-4032,封3.
[14] 王惠琴,黄丽,杨颖.护士长同理心培训方案设计与应用研究[J].护理与康复,2014, 13(7):619-622,626.DOI:10.3969/j.issn.1671-9875.2014.07.001.
[15] 周琴飞,张亚林.医学生同理心的研究进展[J].医学与哲学(人文社会医学版), 2011,32(5):46-48.
[16] 项俊之,季诚.医学生同理心影响因素及干预策略的研究进展[J].医学与哲学,2016, 37(12A):69-72.DOI:10.12014/j.issn.1002-0772.2016.12a.19.
[17] 程赓,董毅,汪凯,等.精神分裂症患者共情能力与社会功能[J].临床精神医学杂志,2010,20(3):145-148.
[18] 章婕,吴振云,方格,等.流调中心抑郁量表全国城市常模的建立[J].中国心理卫生杂志,2010,24(2):139-143.DOI:10.3969/j.issn.1000-6729.2010.02.015.
[19] Chen Po-Jui, Huang Chien-Da, Yeh San-Jou. Impact of a narrative medicine programme on healthcare providers' empathy scores over time[J].BMC Medical Education,2017,17(1):108.DOI:10.1186/s12909-017-0952-x.
[20] Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care[J].BMC Medical Ethics,2016,17(1):8.DOI: 10.1186/s12910-016-0091-7.
[21] 安连超,耿艳萌,陈靖涵.大学生共情与亲社会行为的关系[J].中国健康心理学杂志, 2017,25(9):1369-1371.DOI:10.13342/j.cnki.cjhp.2017.09.024.
[22] Williams B, Brown T, McKenna L, et al. Student empathy levels across 12 medical and health professions: an interventional study[J].Journal of Compassionate Health Care,2015(2):4.DOI:10.1186/s40639-015-0013-4.
[23] Mahoney S, Sladek RM, Neild T, et al. A longitudinal study of empathy in preclinical and clinical medical students and clinical supervisors[J].BMC Medical Education,2016,16(1):270.DOI:10.1186/s12909-016-0777-z.
[24] Tamayo CA, Rizkalla MN, Henderson KK. Cognitive, behavioral and emotional empathy in pharmacy students: targeting programs for curriculum modification[J].Frontiers in Pharmacology,2016(7):96.DOI:10.3389/fphar. 2016.00096.
[25] Quince TA, Kinnersley P, Hales J, et al. Empathy among undergraduate medical students: a multi-centre cross-sectional comparison of students beginning and approaching the end of their course[J].BMC Medical Education,2016,16(1): 92.DOI:10.1186/s12909-016-0603-7.
[26] Wen DL, Ma XD, Li HH, et al. Empathy in Chinese medical students: psychometric characteristics and differences by gender and year of medical education [J].BMC Medical Education,2013,13(1):130.DOI:10.1186/1472-6920-13-130.
[27] Williams B, Sadasivan S, Kadirvelu A. Malaysian medical students' self-reported empathy: a cross-sectional comparative study[J].The Medical Journal of Malaysia,2015,70(2):76-80.
