上海市住院医师规范化培训对住院医师病史采集方式的影响  

Effect of Shanghai＇s standardized training of residents on the history taking mode of physicians

作　　者：吴曦[1] 杨鑫然[2] 汪斌[2] 黄清海[1] 杨志刚[1] 陈剑春[1] 刘建民[1] 

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433 [2]第二军医大学附属长海医院教务科,上海200433

出　　处：《中华医学教育探索杂志》2013年第4期338-341,共4页Chinese Journal of Medical Education Research

基　　金：全国教育科学国防军事教育学科“十二五”规划军队专项课题（PLA112060）;全军医药卫生科研基金（2012XL012）;长海医院教育改革研究课题（CHJG2012010、CHJG2012017）

摘　　要：目的评估2010年在长海医院接受住院医师规范化培训（规培）的医师病史采集方式在不同学位间以及规培前后的分布差异，并以此评估未来规培住院医师接受规范化临床沟通技能培训的必要性。方法分别在规培前后，对2010年起在长海医院接受规培的81名临床医学专业毕业生进行病史采集方式分类，分为：无效沟通方式、传统方式、疾病一患病方式及卡尔加里一剑桥方式4类。以Fisher确切概率法计算规培前不同学位医师应用病史采集方式的差异（n=0．05），以PearsonX2检验计算规培前后所有医师应用病史采集方式的差异（n=0．05）。结果规培前19．8％的医师应用无效沟通方式采集病史，53．O％应用传统方式采集病史，使用疾病一患病方式和卡尔加里一剑桥方式的分别为22．2％、4．9％。不同学位医师应用沟通方式的差异有统计学意义（P=0．008）。规培后医师病史采集方式发生显著的改变，差异有统计学意义（P=0．001）；仅有约1．2％的医师仍应用无效沟通方式，59．3％应用传统方式采集病史，34．6％应用疾病一患病方式，而应用卡尔加里一剑桥方式的医师没有增加。结论不同学位的规培医师间，病史采集方式存在显著差异。住院医师病史采集方式在规培前后有着显著差异，但部分住院医师的病史采集方式仍不适宜临床工作。住院医师在临床沟通技能方面有接受规范化培训及考核的必要。Objective To evaluate the needs of performing a standardized communication skill training program for residents according to the differences in history taking mode of residents with differ- ent degrees and before and after the standardized training in Shanghai Changhai Hospital in 2010. Methods History taking modes of 81 residents in 2010 before and after the standardized training in Shanghai Changhai hospital were categorized. History taking modes were classified into： no effective- ness mode, traditional mode, disease-sickness mode and Calgary-Cambridge Guide mode. Distribution differences of history taking mode of residents with different medical degrees were analyzed by Fisher exact probabilitymethod （α = 0.05）. Distribution differences of history taking mode of residents before and after standardized training were analyzed by Pearson X2 test （α = 0.05）. Results 19.8% resi- dents took no effectiveness mode, 53.0% took traditional mode and 27.2% used disease-sickness mode. There were significant differences in history taking modes among residents with different medical degrees （P = 0. 008 ）. After training, history taking modes of residents were significantly changed （P=0. 001）, only 1.2% residents used no effectiveness mode, 59.3% used traditional mode and 34. 6% used disease-sickness mode. But residents using the Calgary-Cambridge mode were not in- creased. Conclusions There are significant differences in history taking modes among residents with different medical degrees. History taking mode of residents changed after standardized training. But some of the residents still use non-optimal history taking modes; therefore a standardized communica- tion skill training program might be needed in the future.

关 键 词：病史采集 住院医师规范化培训 医患沟通 医学教育 评估 

分 类 号：R44[医药卫生—诊断学]