AIM:To assess the reasons for,and factors associated with,patient-initiated changes in treating specialist in inflammatory bowel diseases(IBD).METHODS:Prospectively identified IBD patients(n = 256) with ≥ 1 encounter...AIM:To assess the reasons for,and factors associated with,patient-initiated changes in treating specialist in inflammatory bowel diseases(IBD).METHODS:Prospectively identified IBD patients(n = 256) with ≥ 1 encounter at a metropolitan hospital were surveyed,including whether they had changed treating specialist and why.Negative reasons included loss of confidence,disagreement,and/or personality clash with the specialist.RESULTS:Of 162 respondents,70(43%) had ever changed specialists;30/70(43%) for negative reasons,52/70(74%) in the preceding year.Patients with negative reasons for changing(n = 30) were younger(median,35.2 years vs 45.3 years),had higher IBD knowledge(median,5.0 years vs 4.0 years),yet had lower medication adherence and satisfaction scores(median,19.0 years vs 22.0 years,14.0 years vs 16.0 years respectively,Mann-Whitney tests,all P < 0.05),compared to all other responders(n = 132).Patients with a recent change(for any reason) were more likely to have Crohn's disease,currently active disease,previous bowel resection and recent hospitalization [OR 2.6,95% CI(1.3-5.4),2.2(1.0-4.7),5.56(1.92-16.67),2.0(1.3-3.0),eachP < 0.05].CONCLUSION:Changing specialist appears associated with patient-related(age,nonadherence) and contemporaneous disease-related factors(recent relapse) which,where modifiable,may enhance patient-doctor relationships and therefore quality of care.展开更多
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...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。展开更多
目的探讨SEGUE[准备(set the stage,S),信息收集(elicitinformation,E),信息给予(giveinformation,G),理解患者(understandthepatient's/family’sperspective,U),结束问诊(end the encounter,E)]框架情景式案例分析教学法在精神科...目的探讨SEGUE[准备(set the stage,S),信息收集(elicitinformation,E),信息给予(giveinformation,G),理解患者(understandthepatient's/family’sperspective,U),结束问诊(end the encounter,E)]框架情景式案例分析教学法在精神科见习生中的应用效果。方法选取2019年9月—2020年12月在中山大学附属第三医院精神科见习的2016级和2017级5年制临床医学专业医学生为研究对象,共204名,将其随机分为试验组、对照组,各102名。试验组采取SEGUE框架下的情景式案例分析教学法,对照组采取传统的教学方法。2组在课程开始前和见习结束时均采用中文版医患沟通技能评价量表(SEGUE量表)对精神科见习生医患沟通能力进行评分。结果干预前,2组SEGUE量表各维度得分比较,差异无统计学意义(P>0.05)。干预后,2组准备、信息收集、信息给予、理解患者、总分以及人文关怀评分均高于干预前,试验组高于对照组,差异有统计学意义(P<0.001)。结论SEGUE框架下情景式案例分析教学法能很好地提高精神科见习生的医患沟通能力,尤其是共情能力和人文关怀能力,可以作为精神科见习医生的医患沟通教学方法的参考方案。展开更多
文摘AIM:To assess the reasons for,and factors associated with,patient-initiated changes in treating specialist in inflammatory bowel diseases(IBD).METHODS:Prospectively identified IBD patients(n = 256) with ≥ 1 encounter at a metropolitan hospital were surveyed,including whether they had changed treating specialist and why.Negative reasons included loss of confidence,disagreement,and/or personality clash with the specialist.RESULTS:Of 162 respondents,70(43%) had ever changed specialists;30/70(43%) for negative reasons,52/70(74%) in the preceding year.Patients with negative reasons for changing(n = 30) were younger(median,35.2 years vs 45.3 years),had higher IBD knowledge(median,5.0 years vs 4.0 years),yet had lower medication adherence and satisfaction scores(median,19.0 years vs 22.0 years,14.0 years vs 16.0 years respectively,Mann-Whitney tests,all P < 0.05),compared to all other responders(n = 132).Patients with a recent change(for any reason) were more likely to have Crohn's disease,currently active disease,previous bowel resection and recent hospitalization [OR 2.6,95% CI(1.3-5.4),2.2(1.0-4.7),5.56(1.92-16.67),2.0(1.3-3.0),eachP < 0.05].CONCLUSION:Changing specialist appears associated with patient-related(age,nonadherence) and contemporaneous disease-related factors(recent relapse) which,where modifiable,may enhance patient-doctor relationships and therefore quality of care.
文摘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。
文摘目的探讨SEGUE[准备(set the stage,S),信息收集(elicitinformation,E),信息给予(giveinformation,G),理解患者(understandthepatient's/family’sperspective,U),结束问诊(end the encounter,E)]框架情景式案例分析教学法在精神科见习生中的应用效果。方法选取2019年9月—2020年12月在中山大学附属第三医院精神科见习的2016级和2017级5年制临床医学专业医学生为研究对象,共204名,将其随机分为试验组、对照组,各102名。试验组采取SEGUE框架下的情景式案例分析教学法,对照组采取传统的教学方法。2组在课程开始前和见习结束时均采用中文版医患沟通技能评价量表(SEGUE量表)对精神科见习生医患沟通能力进行评分。结果干预前,2组SEGUE量表各维度得分比较,差异无统计学意义(P>0.05)。干预后,2组准备、信息收集、信息给予、理解患者、总分以及人文关怀评分均高于干预前,试验组高于对照组,差异有统计学意义(P<0.001)。结论SEGUE框架下情景式案例分析教学法能很好地提高精神科见习生的医患沟通能力,尤其是共情能力和人文关怀能力,可以作为精神科见习医生的医患沟通教学方法的参考方案。
