醫學生修習「醫病關係與溝通技術」課程後之學習成效探討

Effect of Patient-Doctor Communications Curriculum on Medical Student Clinical Performance

10.6145/jme.201003_14(1).0003

蔡詩力(Shih-Li Tsai)；楊志偉(Chih-Wei Yang)；葉啟娟(Chih-Chuan Yeh)；何明蓉(Ming-Jung Ho)；吳美環(Mei-Hwan Wu)；賴鴻緒(Hong-Shiee Lai)；張上淳(Shan-Chwen Chang)；倪衍玄(Yen-Hsuan Ni)

醫病溝通 ； 整合性縱貫式課程 ； 標準化病人 ； 臨床能力 ； patient-physician communication ； integrated longitudinal curriculum ； standardized patient ； clinical competency

Journal of Medical Education

14卷1期（2010 / 03 / 01）

23 - 35

繁體中文

Aim: Patient-physician communication is an essential core clinical competency that is indispensable to medical education. A literature review suggests that an integrated longitudinal design is the best way to develop this curriculum. The aim of this study is to determine the effectiveness of a pilot integrated communication curriculum for medical students. Methods: A communication curriculum was developed taking into consideration the local cultures. Forty-nine medical students who were undertaking their 6-week pediatric internship training between April 2008 and June 2008 were recruited to participate in this study. Students were assigned to either the intervention group or the control group. The twenty-five students in the intervention group received a four-hour pilot course in the first week of their 6-week training. The twenty-four students in the control group did not take the pilot course. The clinical communication skills of all 49 students were evaluated by the clinical faculty during the group objective structured clinical examinations (GOSCEs) at the end of pediatric internship. Results: Students exposed to the intervention performed significantly better than those in the control group in terms of their overall GOSCE results (85% vs. 76%; 9% difference; 95% Confidence interval [CI]: 5.5%~12.4%; p＜0.005). The major items in the overall results that showed significant differences included the areas of open-ended questions (13% difference, 95% CI:7.6%~18.6%; p＜0.005), active listening without interrupting the patient (9.8% difference, 95% CI:4.2%~15.4%; p＜0.005), avoiding using jargon (13% difference, 95% CI:7.6%~18.6%; p＜0.005) and organization/time management (10.6% difference, 95% CI:4.2%~16.8%; p＜0.005). Conclusion: Clinical communication skills can be taught and learned. A communication curriculum based on a locally established educational model should significantly improve the seventh-grade students' overall communications competence.

Aim: Patient-physician communication is an essential core clinical competency that is indispensable to medical education. A literature review suggests that an integrated longitudinal design is the best way to develop this curriculum. The aim of this study is to determine the effectiveness of a pilot integrated communication curriculum for medical students. Methods: A communication curriculum was developed taking into consideration the local cultures. Forty-nine medical students who were undertaking their 6-week pediatric internship training between April 2008 and June 2008 were recruited to participate in this study. Students were assigned to either the intervention group or the control group. The twenty-five students in the intervention group received a four-hour pilot course in the first week of their 6-week training. The twenty-four students in the control group did not take the pilot course. The clinical communication skills of all 49 students were evaluated by the clinical faculty during the group objective structured clinical examinations (GOSCEs) at the end of pediatric internship. Results: Students exposed to the intervention performed significantly better than those in the control group in terms of their overall GOSCE results (85% vs. 76%; 9% difference; 95% Confidence interval [CI]: 5.5%~12.4%; p＜0.005). The major items in the overall results that showed significant differences included the areas of open-ended questions (13% difference, 95% CI:7.6%~18.6%; p＜0.005), active listening without interrupting the patient (9.8% difference, 95% CI:4.2%~15.4%; p＜0.005), avoiding using jargon (13% difference, 95% CI:7.6%~18.6%; p＜0.005) and organization/time management (10.6% difference, 95% CI:4.2%~16.8%; p＜0.005). Conclusion: Clinical communication skills can be taught and learned. A communication curriculum based on a locally established educational model should significantly improve the seventh-grade students' overall communications competence.

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