标准化病人在全科住院医师接诊技能培训中的应用

Application of standardized patients in consultation skills training for resident general practitioners

目的评价标准化病人（standardized patients，SP）在全科住院医师接诊技能培训中的作用。方法采用sP对2008年5月至7月上海市全科医师规范化培训的52名全科住院医师的接诊技能进行评价，其中SP评估内容为临床技能（包括病史采集、体格检查）；教师评估内容包括临床技能（病史采集和体格检查）、临床思维（诊断、鉴别诊断和治疗计划）、健康教育、门诊病史书写和接诊时间控制5个方面。随后SP对住院医师接诊技能反馈指导，教师针对住院医师在接诊中的问题进行授课、小组讨论等形式的培训。2个月后再次采用SP进行接诊技能的评价，比较2次接诊评分和合格率。结果培训后SP对住院医师接诊临床技能评分的合格率高于培训前（88．5％比46．2％，P〈0．01）。教师对其评分的合格率也高于培训前（86．5％比51．9％，P〈0．01），其中培训后临床技能和健康教育合格率均高于培训前（分别为80．8％比46．2％，88．5％比67．3％，均P〈0．01）；临床思维、病史书写和接诊时间控制合格率培训前后差异无统计学意义（分别为71．2％比51．9％，100．0％比100．0％，100．0％比100．0％，均P〉0．05）。结论采用SP能较好地提高全科住院医师临床接诊技能能力，尤其是在病史采集、体检方面，但在临床思维方面尚有待提高。

Objective To assess standardized patients （SP） in resident general practitioners training for their consultation skills to explore its role in clinical competence training. Methods SP are employed in standardized training for 52 resident general practitioners in Shanghai during May to July 2008 to assess trainees＇ clinical consultation skills, including medical history taking and physical examinations, as well as clinical competencies of trainers including medical history taking, physical examinations, clinical thinking （diagnosis, differential diagnosis and treatment plans）, health education, medical record writing, and reception time management. Feedback and appraisal for their consultation skills were provided by SP later. Problems encountered in trainees＇ consultation were discussed in group manner with their trainers. And two months later, assessment with SPs was undergone again for their consultation skills to compare their scores in consultation skills and percentages of them passing the assessment before and after training. Results Trainees were enrolled in the training aged （28 ＋ 1 ） years in average （with a ratio of men to women of 19/33 ）. Percentage of trainees passing the assessment by SP for consultation skills was significantly higher after training （ 88.5% ） than that before it （ 46. 2% ） （ P 〈 0. 01 ）. Percentage of trainees with scores passing assessment by trainers was also significantly higher after training than that before it （86. 5% vs. 51.9% , P 〈 0. 01 ）, with a percentage of those qualified for clinical skills and health education after training of 80. 8% and 88.5% , respectively, as compared to those of 46. 2% and 67.3% , respectively before it, （P 〈0. 01）, and with a percentage of trainees qualified for clinical thinking, outpatient medical record writing and reception time management not changed after training （71.2% , 100. 0% , 100. 0%, respectively） as compared to those before it （51.9%, 100. 0% and 100. 0%, respectively） （ P 〉 0. 05 ）. Conclusions Application of SP can effectively enhance consultation skills of the trainees, especially in their medical history taking and physical examinations. However, there is still rooms to improve in their clinical thinking.