目的 评价老年综合评估在医患沟通教学中的应用效果。 方法 选取2017年7月~2018年6月在南京医科大学第二附属医院实习的南京医科大学2013级临床医学专业187名学生为研究对象。以简单随机抽样法将研究对象分为实验组与对照组。实验组借助老年综合评估量表实施医患沟通教学。对照组实施传统的医患沟通教学。实习前后应用医患沟通量表分别对两组学生医患沟通能力进行评估。 结果 教师对学生进行的医患沟通能力评价结果显示,培训后实验组学生在医患关系建立[3(3,4)分比2(1,3)分]、信息采集[4(4,4)分比2(1,3)分]、信息给予[4(3,4)分比2(1,3)分]、理解患者[3(3,4)分比2(2,3)分]、结束问诊能力[3(3,4)分比2(2,3)分]方面较培训前明显提高,且均优于对照组学生[3(2,4)分、2(2,3)分、3(2,4)分、3(2,3)分、3(2,3)分],差异均具有统计学意义(均P<0.01)。患者或陪护人员的评价结果显示,实验组学生在尊重[4(4,4)分比4(3,4)分]、启示兴趣[4(3,4)分比3(3,4)分]、鼓励提问[4(3,4)分比4(3,4)分]、采用通俗易懂语言[4(3,4)分比3(3,4)分]及总分[22(21,23)分比21(19,23)分]优于对照组学生,差异均具有统计学意义(均P<0.01)。学生自我评价结果显示,实验组学生信息传递[4(3,4)分比3(2,3)分]、情感交流[4(3,4)分比3(3,4)分]及总分[14(14,15)分比14(13,14)分]优于对照组学生,差异均具有统计学意义(均P<0.01)。结论 在实习教学中应用老年综合评估可以提高学生医患沟通能力,为优化医患沟通教学改革提供了新的思路。

Objective To evaluate the application effect of comprehensive geriatric assessment in the teaching of doctor-patient communication. Methods Totally 187 clinical medical students of Grade 2013 Nanjing Medical University who were interned in the Second Affiliated Hospital of Nanjing Medical University from July 2017 to June 2018 were selected as subjects. The students were randomly divided into experimental group and the control group by simple random sampling methods. The experimental group joined in the comprehensive geriatric evaluation for the teaching of doctor-patient communication, while the control group was given traditional teaching. Before and after the internship, the communication abilities of the two groups of students were assessed. Results The evaluation results of doctor-patient communication ability from teachers showed that the experimental group had significantly higher scores in establishing the doctor-patient relationship [3(3,4) vs 2(1,3)], gathering information [4(4,4) vs 2(1,3)], giving information [4(3,4) vs 2(1,3)], undersanding patients [3(3,4) vs 2(2,3)] , and ending inquiry ability [3(3,4) vs 2(2,3)] before the training, and had significantly higher scores than those [3(2,4), 2(2,3), 3(2,4), 3(2,3), 3(2,3)] in the control group (all P<0.01). Patients or accompanying staff assessed that students in the experimental group had significantly higher scores in respect [4(4,4) vs 4(3,4)], inspiration interest [4(3,4) vs 3(3,4)], encouragement of questioning [4(3,4) vs 4(3,4)], easy-to-understand language [4(3,4) vs 3(3,4)] and total scores [22(21,23) vs 21(19,23)] than those in the control group(all P<0.01). Students self-evaluation showed that medical students in the experimental group had significantly higher scores in information transmission [4(3,4) vs 3(2,3)], emotional communication [4(3,4) vs 3(3,4)] and total score [14(14,15) vs 14(13,14)] than those in the control group (all P<0.01). Conclusions The application of comprehensive geriatric assessment could improve students' ability of doctor-patient communication and provide new ideas for optimizing the teaching reform of doctor-patient communication.