案例分析教学法联合教师标准化病人在卒中后神经源性膀胱临床沟通教学中的应用

Application of Case-Based Learning Combined with Teacher-Standardized Patient in Clinical Communication Teaching for Post-Stroke Neurogenic Bladder

目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分为对照组和试验组。对照组采用传统以授课为导向的教学法,试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通,共计12学时。教学结束后使用TSP和医患沟通技能评价量表(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE)评估住院医师的医患沟通能力。结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后,试验组在SEGUE的问诊准备[(4.6±0.6)分vs.(3.7±0.8)分,P<0.0001]、信息采集[(8.6±1.1)分vs.(7.3±0.9)分,P<0.0001]、信息提供[(3.7±0.5)分vs.(3.3±0.6)分,P=0.0099]、患者理解[(3.5±0.4)分vs.(2.4±0.7)分,P<0.0001]及总分[(22.1±1.5)分vs.(18.5±2.0)分,P<0.0001]方面均显著高于对照组,在问诊结束[(1.7±0.6)分vs.(1.7±0.5)分,P=0.6305]方面与对照组差异无统计学意义。结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段,从而提高医疗服务质量。

Objective To explore the effect of case-based learning(CBL)combined with teacher-standardized patient(TSP)in the teaching of doctor-patient communication for post-stroke neurogenic bladder.Methods Sixty residents undergoing standardized training at Beijing Tiantan Hospital,Capital Medical University,were included and randomly divided into a control group and an experimental group.The control group received traditional lecture-based learning,while the experimental group received the CBL combined with the TSP approach.The teaching content was a course on doctor-patient communication regarding post-stroke neurogenic bladder,with a total of 12 class hours.After the teaching sessions,residents’doctor-patient communication skills were assessed using TSP and the set elicit give understand end scale(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE).Results There were no significant differences between the control group and the experimental group in terms of age,gender,theoretical exam scores,and operational exam scores at baseline.Following the teaching sessions,residents in the experimental group scored significantly higher than the control group on the SEGUE in the areas of setting the stage[(4.6±0.6)points vs.(3.7±0.8)points,P<0.0001],eliciting information[(8.6±1.1)points vs.(7.3±0.9)points,P<0.0001],giving information[(3.7±0.5)points vs.(3.3±0.6)points,P=0.0099],understanding the patient’s perspective[(3.5±0.4)points vs.(2.4±0.7)points,P<0.0001],and total score[(22.1±1.5)points vs.(18.5±2.0)points,P<0.0001].There was no significant difference between the experimental group and the control group in ending the encounter[(1.7±0.6)points vs.(1.7±0.5)points,P=0.6305].Conclusions The teaching method of CBL combined with TSP can significantly improve the doctor-patient communication skills of residents in dealing with post-stroke neurogenic bladder.This teaching strategy holds promise as an effective means to enhance doctor-patient communication skills in medical education and improve the quality of medical service.