早期临床接触活动对改善医学生医患关系认知的效果评价

Evaluating the effect of early clinical exposure in improving medical students＆#39; cognitive aspects of the doctor-patient relationship

目的：探究早期临床接触活动在改善医学生对当前医患关系认知方面的效果。方法采用简单随机抽样，从西安交通大学医学院已参与早期临床接触活动的2010级（n=280）和未参与该活动的2011级（n=280）本科生中，各抽取140名进行问卷调查；调查数据用Microsoft Excel录入计算机，并用SPSS对2个年级的数据行卡方检验/Fisher精确检验。应用焦点小组访谈法、深度访谈法对学生、带教教师、辅导员、从事医患关系研究的专家进行访谈，用主题分析法对收集资料进行整理分析。问卷调查和访谈涉及的主要内容为：活动细节、活动参与度/兴趣、对医患关系总体认知、专业热爱度、择业观、活动对医学生医患关系认知方面的作用及对于活动的建议和意见。结果2010级收回有效问卷134份，2011级124份。2010级学生早期临床接触活动参与率为94.0%（126/134），2011级对该活动感兴趣的学生占76.6%（95/124）。2010级学生在医患关系认知方面优于2011级（P=0.0192）；早期临床接触活动对2个年级学生专业热爱度影响差异无统计学意义（P=0.7372），对其择业观影响差异有统计学意义（P=0.0002）。访谈主题词聚类为“活动前准备不够充分”“时间安排不够合理”“带教教师”“激发职业自豪感”。结论早期临床接触活动可以有效改善医学生对当前医患关系的认知，但活动实施方法和相应政策方面尚存在不足，需要后期探究和改善。

Objective This paper explored the effect of the early clinical exposure in im-proving medical students＆#39; cognitive aspects of the doctor-patient relationship. Methods （1）From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi＆#39;an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test（P〈0.05）. （2）We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. （3）The main aspects of questionnaires and interviews were： details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students＆#39; cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010（participating group） was 94.0%（126/134）, while the interest rate of undergraduates of Grade 2011 （control group） was only 76.6%（95/124）. Participating group had a better cognitive understanding of doctor-patient relationship than control group（P=0.0192）. The activities had significant effects on choice of career（P=0.0002）, and no effect on passion for profession（P=0.7372）. There was statistically significant difference on their views of employment（P=0.0002）. The key words for the interview were： not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students＆#39; awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.