神经科住院医师医患沟通能力评估初探 An Investigation of the Current Status of Doctor-Patient Communication Skills among Neurological Residents

目的 沟通技能是神经科住院医师必须掌握的核心能力之一。本研究旨在了解神经科住院医师医患沟通技能现况，并初步探讨可能的提升方式。 方法 选择北京协和医院神经科25名住院医师为研究对象，在进行年度客观结构化临床考试（objective structured clinical examination，OSCE）考核时，同期采用医患沟通技能评价（set elicit give understand end，SEGUE）量表评估其医患沟通能力，SEGUE量表包括5个维度，分别是“问诊准备”“信息收集”“信息给予”“理解患者”及“结束问诊”，共计25分。分析神经科住院医师医患沟通能力的常见薄弱环节、表现方式，并初步探讨可能的提升措施。 结果 25名住院医师均接受了医患沟通能力评估，平均分为（20.78±3.85）分，不同性别住院医师之间的差异无统计学意义[（20.81±3.68）分 vs.（20.50±4.29）分，P=0.86]。各评估维度平均分由高到低依次为“问诊准备”“理解患者”“信息收集”“信息给予”及“结束问诊”。其中，“进一步说明下一步诊疗方案”单项得分最低，“询问患者是否还有其他问题需要探讨”和“解释诊断性操作的理论依据”两项得分也较低。按照住院医师入职年限进行亚组分析，结果显示住院医师的医患沟通能力虽然随着入职年限增加而升高，但组间差异不具有统计学意义，且各组间不足之处相仿。 结论 神经科住院医师医患沟通能力存在欠缺，且这种不足并未随着临床实践的积累得到显著提高。提高神经科住院医师的医患沟通能力，不仅需要持续提升专业技术能力，还要积极倡导开设系统、专业的医患沟通培训课程，从医疗技术和沟通技术两方面提高医患沟通的效果。 Abstract: Objective Communication skills are one of the core competencies in neurology residency training. This paper aimed to investigate the current status of doctor-patient communication skills among neurological residents, and thus explore possible means to improve them. Methods A total of 25 resident physicians in the neurology department of Peking Union Medical College Hospital were selected as the study subjects, and the doctor-patient communication skills was evaluated by set elicit give understand end (SEGUE) framework during the annual objective structured clinical examination (OSCE). The SEGUE framework consists of 5 dimensions with a full score of 25 points. They are "set the stage" "elicit information" "give information" "understand the patients" and "end the encounter". To analyze the common weaknesses and manifestations of doctor-patient communication skills of neurology residents, and then discussed the possible improvement measures. Results All of the 25 residents received evaluation of doctor-patient communication skills with a mean score of 20.78±3.85, and the difference between different genders was not statistically significant (20.81±3.68 vs. 20.50±4.29, P=0.86). The dimension of "set the stage" reached the highest score, followed by "understand the patients" "elicit information" "give information" and "end the encounter". Among all of the items, the score of item "review next steps with patient" was the lowest, the other two items, "ask if there is anything else patient would like to discuss" and "explain rationale for diagnostic procedures", also had very low scores. Subgroup analysis based on the employment year of resident showed that although the doctor-patient communication skills of residents improved with the increasing of employment year, the difference between the subgroups was not statistically significant. A similar pattern of shortcomings was observed among the different subgroups. Conclusions Doctor-patient communication skills of neurological residents are insufficient, which could not be significantly improved with the accumulation of clinical practice. To improve the doctor-patient communication skills of neurology residents, it is not only necessary to continuously improve the professional technical ability, but also to actively advocate the establishment of systematic and professional doctor-patient communication training courses. Improve the effect of doctor-patient communication from two aspects of medical technology and communication technology