标准化病人在助理全科医生门诊接诊能力培训中的应用效果分析

Using standardized patients in training of assistant general practitioners

为探讨有效提高助理全科医生接诊能力的培训方法，提高其规范接诊患者的能力，2014年1—4月，上海市嘉定区助理全科医生规范化培养的住院医生30人以接诊标准化病人（SP）的方式进行社区门诊临床接诊能力培训以及医患交流技能培训。培训2个月后，分别由sP和带教老师对助理全科医生的临床技能和医患交流技能进行评价，比较其培训前后临床接诊能力的差异。结果显示，助理全科医生培训后临床技能评分[（72±5）比（56±7）分，t=7．871，P〈0．05]，医患交流技能评分[（71±4）比（45±5）分，t=9．573，P〈0．05]均有增加。培训后助理全科医生5项临床技能评价指标中的信息收集[（36±5）比（28±6）分，t=4．352]、临床思维[（17±2）比（14±3）分，t=3．974]、健康宣教[（3±1）比（2±1）分，t=3．090]和门诊病史书写[（13±1）比（8±2）分，t=5．317]4个方面评分均高于培训前（均P〈0．05）；而在接诊时间控制方面，培训前后评分[（4±0）比（4±0）分，t=1．025]差异无统计学意义（P〉0．05）。培训后助理全科医生5项医患交流技能评价指标中的建立医患关系[（20±3）比（15±4）分，￡=4．056]、信息收集和反馈[（22±4）比（13±3）分，t=4．682]、从患者角度理解问题[（5±2）比（3±2）分，t=3．107]、信息共享和知情同意[（19±4）比（11±5）分，t=4．322]和结束就诊[（6±2）比（3±1）分，t=2．987]5个方面评分均高于培训前（均P〈0．05）。提示接诊SP的培训方式有助于提高助理全科医生的临床技能和医患交流技能。

Thirty assistant general practitioners （GPs） of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients （SP） in outpatient department from January to April 2014. The scores of clinical skills and communication skills were evaluated and compared before and two months after training. The results showed that the score of clinical skills [ （72 ±5） vs （56 -± 7）, t=7.871, P〈0.05] and communication skills [（71±4） vs （45 ±5）, t=9.573, P〈0.051 were significantly improved after training. After training, the scores of medical history taking [ （36 ± 5） vs （28 ± 6）, t = 4. 352 ], clinical thinking [ （ 17± 2） vs （ 14 ± 3 ）, t = 3.974 ], health education [ （3 ± 1 ） vs （2 ± 1 ）, t = 3. 090 ] and medical record writing [ （ 13 ± 1 ） vs （ 8 ± 2 ）, t = 5.317 ] were significantly higher than those before training （ all P 〈 0. 05 ）. But there was no difference in reception time management [ （4 ± 0） vs （4 ±0）, t = 1. 025] before and after training （P 〉0. 05）. After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [ （ 20 ± 3 ） vs （ 15 ± 4 ）, t = 4. 056], collecting information and providing feedback [ （22 ± 4） vs （ 13 ± 3 ） , t = 4. 682 ] , understanding complaints from patients＇ perspective [ （5 ± 2） vs （3 ± 2）, t = 3. 107 ], sharing information and obtaining informed consent [ （ 19 ±4） vs （ 11 ±5）, t =4. 322] and closing consultation [ （6 ±2） vs （3 ± 1 ）, t =2. 987] were higher than before training （ all P 〈 0. 05 ）. The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs.