三阶段临床实践对医学生叙事医学认知的影响研究

The impact of three-stage clinical practice on medical students'cognition of narrative medicine

目的探索三阶段临床实践教学模式对医学生叙事医学认知的影响。方法 2020年4月至5月,采用自行设计的问卷对上海健康医学院2016级~2019级五年制临床医学专业472名学生进行调查。三阶段"叙事医学"教学分别安排在第一学年至第三学年的小学期。对经历不同阶段临床实践的医学生关于叙事医学认知情况进行比较。结果随着三阶段临床实践的递进,4个年级学生对叙事医学概念、发展、平行病历、写作技巧的了解程度逐步深入,其差异均具有统计学意义(均P<0.01)。倾听时间在10分钟以内的学生占比随着年级的增长而下降,2019级~2016级分别为32.0%(40/125)、23.2%(32/138)、21.2%(24/113)、15.6%(15/96),其差异具有统计学意义(P=0.034)。在已经进行临床实践的3个年级中,90%以上的学生认为叙事医学实践对职业精神的培养、对医患共情能力的培养、对医患沟通能力的培养均有所帮助。结论分阶段临床实践教学模式可以提高医学生对叙事医学的认知,叙事医学教学模式得到了学生的认可。

Objectives To explore the impact of the three-stage clinical practice approach on medical students'cognition of narrative medicine.Methods A self-designed questionnaire was used to compare the cognition degree of narrative medicine among the students of clinical medicine from grade 2019,2018,2017,and 2016 in Shanghai University of Medicine and Health Sciences from April 2000 to May 2000.The three-stage"narrative medicine"teaching was arranged in the third semester in the first,second and third school year.Results With the advancement of three-stage clinical practice,students'understandings of the concept,development,parallel medical records,and the writing skills of narrative medicine gradually deepened(all P<0.001).During the communication between doctors and patients,the percentage of listening time within 10 minutes gradually decreased as the practice progresses(P=0.034).More than 95%of students who have received narrative medical practice in the three grades thought that narrative medical practice was helpful for the cultivation of professionalism,empathy between doctors and patients,and communication capacity between doctors and patients.Conclusions Medical students'cognitions of narrative medicine have been improved by the staged curriculum based clinical practice teaching,and the teaching model has been well recognized by students.