教学医院巴林特小组案例的质性研究

Qualitative study of Balint group cases in teaching hospital

目的 通过巴林特小组案例分析,解析目前医学生在临床实习过程中的负性体验,探索医学生医患沟通培训的新方法.方法 在复旦大学附属中山医院院组织10次有医学生参加的巴林特小组活动,共呈现10个临床案例,采用扎根理论的方法对讨论记录进行质性分析.结果 案例发生的情境主要包括医患互动、团体协作,职业发展规划和个人生活的冲突；案例呈现的触发事件包括医患冲突、价值观冲突、面对“无法治愈的患者”的困惑、职业角色模糊、本人或患者遭受不公正待遇；小组讨论的主题包括与患者相关的情感体验、职业发展定位、医疗团队的合作、医学生临床教学.结论 巴林特小组可以帮助临床医学生识别和处理医患沟通中复杂的情绪反应（自己的和患者的）,澄清职业角色的要求,提高团队合作效能、提升工作满意度.

Objective To analyze the negative experience from medical practice of medical students by Balint group case study, and to explore new approach for training doctor-patient communication skills. Methods 10 times of Balint group activities were held in Zhongshan Hospital of Fudan University,with one case each time. Grounded theory approach were applied for analyzing discussion record. Results The cases were oc- curred in doctor-patient interaction, teamwork, conflict between one＇s personal life and vocational development plan- ning. Trigger events involved doctor-patient conflict, conflict of values, decision making problem while confronted with incurable patients, role ambiguity, unfair treatment. Topics of discussion included emotional experience with patients, career development orientation, medical teamwork, clinical education of medical student. Conclusion Through practice of Balint group, medical students in teaching hospital can improve their awareness of complicating psycho-social problem of patients and themselves, as well as handling it. And it can improve the professional identi- ty, professional growth and professional self-identity.