臨床溝通技能教學、評估與課程整合工作坊紀實

Special Report on a Faculty Development Workshop on Clinical Communication

10.6145/jme.201106_15(2).0012

蔡詩力(Shih-Li Tsai)；陳聖欣(Sheng-Hsin Chen)；鄭敏潔(Min-Jie Zheng)；何明蓉(Ming-Jung Ho)

臨床溝通技能 ； 關係為中心的照護 ； 反思式回饋教學 ； clinical communication ； relationship centered care ； reflective feedback

Journal of Medical Education

15卷2期（2011 / 06 / 01）

191 - 198

繁體中文

良好的臨床溝通技能，有助於醫師與患者間的溝通，幫助釐清病人的問題，提高診斷的準確性，同時亦能增加病人對於醫囑的順從性，對於醫病雙方皆有正面影響。而溝通技能的教學要做好，教學與評估之內涵必須同步；反思式回饋教學也有助於醫病溝通的教學，利用開放式問題引發學生省思，並內化經驗以運用在下一次的醫療訪談。臨床溝通技能教學、評估與課程整合為目前醫學教育重要之新興議題，歐美醫學院校亦積極搜集相關證據以評估其教學成果。本次兩天的工作坊，首日主要包含四個子題：「臨床溝通技能的重要性」、「如何教授臨床溝通技能」、「影響醫病關係的重要因素」、「人際關係技巧與溝通技巧的評估」。次日則是有關「溝通技能之教學與評估」與「哈佛醫學院課程整合之經驗」。本文之目的乃希望藉由工作坊的回顧，將工作坊重點整理出來，提供國內相關教學與研究學者參考。

Effective clinical communication skills are able to enhance the quality of physician-patient communication, clarify patients' problems, and facilitate diagnostic accuracy. In addition, effective clinical communication skills help patients follow the doctor's advice, which positively impacts on both physicians and patients. Teaching and assessment of communication skills must be consistent. Interpersonal relationship and communication skills should be considered simultaneously and should especially focus on the physician-patient relationship, on the patient' perspectives, and on relationship-centered care. Evaluation of the relationship between physicians, patients and colleagues should also be emphasized. The Reflective Feedback model for teaching such skills can be divided into several steps: ”establishing a rapport with the learner”, ”ask about the individual's learning goals as part of observation”, ”inviting the learner to share their reflections on the 'why' insights”, ”sharing your reflections with the learner”, ”checking for understanding”, and ”making a follow-up plan”. Using open-ended questions, the students will be inspired to think about the whole process of interviews, which will result in the learned experiences being internalized and then applied to different situations. Recently, the integration of teaching, assessment and curriculum development means that clinical communication skills have begun to play an even more important role in medical education. Medical institutions in the West have begun to actively collect evidence to confirm their teaching outcomes. By reporting on this workshop, we hope topics related to clinical communication skills may attract more attention in Taiwan and this will help to improve teaching and research in related areas.

1. Tsai, S.L.、Yang, C.W.、Yeh, C.C.(2010)。Effect of patient- doctor communications curriculum on medical student clinical performance。Journal of Taiwan Medical Education，14(1)，23-35。
   連結：
2. Rider EA: Teaching medicine through student self-reflection. Focus: Harvard Medical, Dental, and Pub1ic Health Schoo1s 2004; 20 Feb., 2004. Avai1ab1e at: [http ://focus.hms.harvard.edu/2004/Feb20_2004/forum.html]
3. Baile, W.F.,Buckman, R.,Lenzi, R.(2000).SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer.The Oncologist,5,302-311.
4. Bennett, N.,Lockyer, J.,Mann, K.(2004).Hidden curriculum in continuing medical education.J Contin Educ Health Prof,24,145-152.
5. Branch, W.T.,Paranjape, A.(2002).Feedback and reflection: Teaching methods for clinica1 settings.Acad Med,77,1185-1188.
6. Ende, J.(1983).Feedback in clinical medical education.JAMA,250,777-781.
7. Hafferty, F.W.(1998).Beyond curriculum reform: Confronting medicine's hidden curriculum.Academic Medicine,73,403-407.
8. Hewson, M.G.,Little, M.L.(1998).Giving feedback in medical education: Verification of recommended techniques.J Gen lntern Med,13,111-116.
9. Jackson, L.(ed.),Duffy, B.K.(ed.)(1998).Health Communication Research: A Guide to Developments and Directions.Westport, C.T.:Greenwood Press.
10. Kritek, P.B.(2002).Negotiating at an Uneven Table: Developing Moral Courage in Resolving Our Conflicts.San Francisco, CA:Jossey-Bass.
11. Krupat, E.,Frankel, R.,Stein, T.(2006).The Four Habits Coding Scheme: Validation of an instrument to assess clinicians' conununication behavior.Patient Education and Counseling,62,38-45.
12. Kurtz, S.,Silverman, J.,Draper, J.(2005).Teaching and Learning Communication Skills in Medicine.Oxford, UK:Radcliffe Publishing.
13. Lipkin, M.,Putnam, S.M.,Lazare, A.(1995).The Medical Interview: Clinical Care, Education, and Research.NewYork:Springer-Verlag.
14. Miller, S.Z.,Schmidt, H.J.(1999).The habit of humanism: A framework for making humanistic care a reflexive clinical skill.Acad Med,74,800-803.
15. Novack, D.H.,Suchman, A. L.,Clark, W(1997).Calibrating the physician: Personal awareness and effective patient care.JAMA,278,502-509.
16. Rider, E.A.(2002).Twelve strategies for effective communication and collaboration in medical teams.BMJ,325,S45.
17. Rider, E.A.,Hinrichs, M.M.(2003).Teaching communication skills: Assessment and reflective feedback.MyCourses web-based faculty develoment teaching module.Harvard Medica1 School.
18. Rider, E.A.,Hinrichs, M.M.,Lown, B.A.(2006).A model for communication skills assessment across the undergraduate curriculum.Medical Teacher,28,e127-134.
19. Silverman, J.,Kurtz, S.,Draper, J.(2005).Skills for Communicating with Patients.Oxford, UK:Radcliffe.
20. Smith, R.C.(2002).Patient-Centered Interviewing, an Evidence-Based Approach.Philadelphia:Lippincott, Williams, and Wilkins.
21. Smith, R.C.,Marshall-Dorsey, A.A.,Osborn, G.G.(2000).Evidence-based guidelines for teaching patient-centered interviewing.Patient Educ Couns,39,27-36.
22. Stewart, M.,Brown, J.B.,Weston, W.W.(2003).Patient-Centered Medicine: Transforming the Clinical Method.Oxford, UK:Radcliffe Medical Press.
23. Suchman, A.L.(2006).A new theoretical foundation for relationship-centered care. Complex responsive processes of relating.J Gen Intern Med,Suppl 1,S40-44.
24. Suchman, A.L.,Markakis, K.,Beckman, H.(1997).A model of empathetic communication in the medical interview.JAMA,277,678.
25. Westberg, J.,Jason, H.(2001).Fostering Reflection and Providing Feedback: Helping Others Learn from Experience.NY:Springer.

1. 莊孟蓉(2021)。運用翻轉教學提升照護溝通之成效。慈惠學報，17，79-98。