基于卡尔加里-剑桥指南的沙龙培训模式提升全科规培医师医患沟通技能的对照研究

A Controlled Study of Salon-training Models Based on the Calgary-Cambridge Guidelines for Improving Patient-physician Communication Skills in General Practice

背景医患沟通技能是全科医生的核心岗位胜任力之一,高水平的医患沟通能力是创建和谐医患关系的基石,有助于提高患者就医获得感和满意度。而我国全科医生沟通能力普遍偏低,有待探索出一种适应我国国情、满足我国全科医生沟通需求的医患沟通培训模式来提高其医患沟通能力。目的探索基于卡尔加里-剑桥指南的沙龙培训模式在全科规培医师医患沟通技能培训中的应用效果,为构建适合我国国情的医患沟通培训体系提供参考依据。方法选取成都市第五人民医院2019—2020年度全科规培医师40名作为研究对象,按照随机数字表法分为沙龙组和对照组,每组20名,其中沙龙组使用基于卡尔加里-剑桥指南的沙龙培训模式进行医患沟通培训,对照组设置为空白对照,培训前、培训后1周分别对两组学员采用标准化病人(SP)模式进行接诊,使用医患沟通评价量表(SEGUE量表)进行现场观察评分,比较两组学员的医患沟通培训效果。结果最终纳入28名,其中沙龙组15名,对照组13名,培训后沙龙组规培医师SEGUE量表评分从(11.80±4.36)分提高至(18.07±4.11)分,对照组规培医师SEGUE量表评分从(12.15±4.63)分提高至(14.46±3.71)分。沙龙组培训后的SEGUE量表评分与培训前的比较,差异有统计学意义(t=3.250,P<0.001);对照组培训后的SEGUE量表评分与培训前比较,差异无统计学意义(t=2.582,P=0.624);培训后对SEGUE量表中的25个项目进行分析,沙龙组与对照组SEGUE量表评分比较,差异有统计学意义(P<0.05)。沙龙组以下5个项目结果优于对照组,准备阶段中的“建立个人信任关系”(93.3%比7.7%)、“保护患者的隐私/尊重患者选择权”(53.3%比15.4%);理解患者阶段中的“认同患者为疾病所付出的努力、改变及其遇到的困难”(33.3%比23.1%)、“表达关心,使患者感到温暖/树立信心”(100.0%比69.2%);结束问诊阶段中的“询问患者是否还有其他的问题需要探讨”(66.7%比23.1%)。结论基于卡尔加里-剑桥指南的沙龙培训模式对全科规培医师进行医患沟通技能培训可增强学员主动参加培训的兴趣和积极性,对于医患沟通能力的提升具有较好的培训效果,值得借鉴和推广。

Background Doctor-patient communication is one of the core abilities of general practitioners.Dophisticated doctor-patient communication skills are the basis foRbuilding a harmonious doctor-patient relationship,and help to improve patients'sense of gain and satisfaction in seeking medical treatment.However,the communication ability of general practitioners in China is generally low,it is necessary to explore a training mode of doctor-patient communication that adapts to China's national conditions and meets the communication needs of general practitioners in China to improve the communication ability between doctors and patients.Objective To explore the application effect of salon training based on the CalgaryCambridge Guide in the training of doctor-patient communication ability of resident doctors in standardized training of general practitioners,and to provide reference foRthe construction of doctor-patient communication training system.Methods Forty cases of general practitioners in Chengdu Fifth People's Hospital Standardized general practice training from 2019 to 2020 were selected as the research object,and randomly divided into salon group and control group,with 20 cases in each group.Salon group used salon training mode based on Calgary-Cambridge guidelines foRdoctor-patient communication training,while the control group was set as blank control.Before the training and one week afteRthe training,the standardized patient(SP)model was adopted to clinical reception in the two groups,and the doctor-patient communication evaluation scale(SEGUE)was used to evaluate the level of doctor-patient communication,and the training effects of the two groups were compared.Results Finally,28 cases were included,including 15 cases in the salon group and 13 cases in the control group.AfteRthe training,the score of the SEGUE scale of the training doctors in the salon group increased from(11.80±4.36)to(18.07±4.11),and that of the training doctors in the control group increased from(12.15±4.63)to(14.46±3.71).The score of SEGUE scale in Sharon group afteRtraining was significantly different from that before training(t=3.250,P<0.001).There was no significant difference in the score of SEGUE scale between the control group afteRtraining and before training(t=2.582,P=0.624).After training,25 items in the SEGUE scale were analyzed,and the difference between the salon group and the control group was statistically significant(P<0.05).The results of the following five items in the salon group were betteRthan those in the control group:"Establishing personal trust relationship"(93.3%vs.7.7%)and"Protecting patients'privacy/respecting patients'right to choose"(53.3%vs.15.4%)in the preparation stage;Understand the patient's stage of"recognizing the patient's efforts,changes and difficulties"(33.3%vs.23.1%)and"expressing concern and making the patient feel warm/confident"(100.0%vs.69.2%);At the end of the consultation stage,"Ask the patient if there are any otheRquestions to discuss"(66.7%vs.23.1%).Conclusion Salon training mode based on Calgary-Cambridge guidelines can enhance students'interest and enthusiasm in participating in the training,which has a good training effect on improving the communication ability between doctors and patients,and is worth learning and popularizing.