标准化病人在全科住院医师接诊医患交流技能培训中的应用

Application of standardized patients in training of communication skills in consultation 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医患交流培训中的作用.方法 2008年5月至7月,采用SP对上海市全科医师规范化培训的52名全科住院医师接诊中的医患交流技能进行培训,包括SP的信息反馈、教师授课和小组讨论等形式.培训前后采用SP对其医患交流技能进行评价,评价内容包括建立医患关系、信息收集和反馈、从患者角度理解问题、信息共享和知情同意、结束接诊5个方面,比较培训前后全科住院医师接诊医患交流评分及合格率的变化.结果 培训后住院医师医患交流技能的总评分高于培训前[（76±13）分比（49±12）分,P＜0.01],总合格率也高于培训前（86.5%比15.4%,P＜0.01）.培训后,医患交流技能中建立医患关系、信息收集和反馈、从患者角度理解问题、信息共享和知情同意、结束接诊5个方面的合格率均高于培训前（90.4%比59.6%,65.4%比5.8%,38.5%比11.5%,86.5%比17.3%,65.4%比3.9%,均P＜0.01）.培训前后住院医师医患交流评分与接诊技能的评分均呈正相关（r值分别为0.55,0.63,均P＜0.01）,培训后住院医师医患交流评分的提高与接诊技能评分的提高也呈正相关（r=0.62,P＜0.01）.结论 采用SP能较好地提高全科住院医师接诊医患交流技能,进而有助于临床接诊能力的提高.

Objective To assess roles of standardized patients （SPs） in training of communication skills for resident general practitioners （GP）. Methods Fifty-two resident GPs were trained for communication skills in consultation with SPs during May to July, 2008, including information feedback from SPs, lectures and group discussion coordinated by instructors on problems developed during residents＇ clinical encounters. Communication skills of the trainees with patients was assessed before and after training, respectively, including building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients＇ perspective, sharing information and obtaining informed consents and closing consultation. Assessment was scored and proportion of trainees qualified for consultation with SPs were estimated. Results Total score of the trainees was higher after training than that before it （76 ± 13 vs. 49 ± 12, P 〈 0. 01 ）, and 86. 5 percent of them qualified for their communication skills after training, as compared to that of 15.4 percent before it. Proportions of the trainees qualified for building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients＇ perspective, sharing information and obtaining informed consents during consultation were higher after training than those before it （90. 4% vs. 59. 6%, 65.4% vs. 5.8%, 38.5% vs. 11.5%, 86. 5% vs.17.3% and 65. 4% vs. 3. 9%, respectively, all P 〈0. 01 ）. Scores of physician-patient communication in the trainees correlated with those of their consultation skills both before and after training （ r = 0. 55 and r =0. 63, both P 〈 0. 01 ）. Increase in scores of physician-patient communication and consultation skills in trainees after training also associated with that in those of clinical skills （ r = 0. 62, P 〈 0. 01 ）. Conclusions Application of SPs can effectively enhance communication skill of resident general practitioners, thus improve their competencies in clinical consultation.