医教协同背景下全科医生沟通技能培训需求及影响因素研究

Training Needs and Influencing Factors of General Practitioners'Communication Skills under the Synergy of Health Care System and Medical Educational System

背景医教协同加强以全科医生为重点的人才培养,是提高医疗卫生保健质量的关键。沟通能力是全科医生必备核心能力之一,尽管我国开展了全科医生沟通技能培训,但效果不佳。研究显示以需求为导向的培训模式可快速满足临床需要,显著提高教学质量。目的探讨在医教协同背景下,全科医生沟通技能培训需求及影响因素。方法采用整群抽样的方法,于2018年10月选取“华西医院-社区”医教协同体下承担全科医师规范化培训的社区基地为调查地点,以其内所有社区卫生服务中心共12家的全部全科医生104名为调查对象进行结构式问卷调查。问卷主要内容包括全科医生基本情况、对医患沟通重要性的认识、既往参加沟通技能培训、沟通技能培训需求和参与意愿、医患沟通影响因素。采用二分类Logistic回归分析全科医生沟通技能培训需求内容的影响因素。结果共发放问卷104份,回收有效问卷104份,有效回收率为100.0%。95.2%(99/104)的全科医生认为医患沟通重要和非常重要,66.3%(69/104)的全科医生既往参加过医患沟通技能培训。在既往培训中接受过建立关系培训的人占比最多,为82.6%(57/69),接受过表达同理心培训的人占比最少,为29.0%(20/69)。全科医生均对沟通技能培训有需求,在培训需求方面共同决策需求占比最高,为71.8%(61/85);采集病史需求占比最低,为16.4%(17/104)。二分类Logistic回归分析结果显示培训需求内容受性别、年龄、文化程度、培训经历、沟通能力和医患关系满意度的影响(P<0.05)。基于全科医生视角影响医患沟通的医方因素中排名第一是“工作任务繁忙,没有时间精力”,其次是“缺乏沟通技巧,不会和患者有效沟通”。结论医教协同背景下全科医生对医患沟通重视,培训需求率高,参与意愿强烈。既往培训内容与培训需求存在差异,持续动态评估培训需求是保证全科医生医患沟通能力培养质量的关键环节。

Background The synergy of health care system and medical educational system aims to foster healthcare talents with a priority on general practitioners(GPs),which is a key to improving health care.Communication skills are one of the core competencies that GPs must master.Although China has opened doctor-patient communication training courses for GPs,the training effect is poor.Studies have demonstrated that the demand-oriented training model may quickly meet the clinical needs and significantly improve the quality of teaching.Objective To explore the training needs and influencing factors of GPs under the synergy of health care system and medical educational system.Methods By use of cluster sampling,we selected the community base of West China Hospital-community consortium for standardized training for GPs in October 2018,and invited 104 GPs from all the 12 community health centers in the consortium to participate in a structured questionnaire survey for collecting their demographic characteristics,perceived importance of doctor-patient communication,previous trainings of doctor-patient communication,needs of related trainings and intention to attend such trainings,and perceived influencing factors for doctor-patient communication.Binary logistic regression analysis was used to analyze the influencing factors associated with training needs of communication skills.Results The survey achieved a 100.0%response rate.Among the respondents,95.2%(99/104)believed that doctor-patient communication was important,and 66.3%(69/104)had attended trainings in doctorpatient communication.The top topic that 82.6%(57/69)of participants had been trained was"building a healthy relationship",the bottom was"empathy training"with 29.0%(20/69).All the respondents had the training needs for communication.The top topic that 71.8%(61/85)of participants would like to be trained was"shared decisions making",and the bottom was"history taking"with 16.4%(17/104).Binary logistic regression analysis found that training needs was influenced by gender,age,education level,previous training experience,self-rated communication skills and doctor-patient relationship satisfaction(P<0.05).The commonest barrier to doctor-patient communication was"lack of time and energy due to busy work",followed by"lack of skills to effectively communicate with patients".Conclusion Under the synergy of health care system and medical educational system,the GPs attached great importance to doctor-patient communication,and demonstrated strong training needs and willingness.There are differences between previous training contents and training needs.Continuous and dynamic assessment of training needs is the key to ensuring the quality of such trainings for GPs.