儿科住院医师医患沟通能力考核评价的设计与研究  

Design and research on evaluation system to pediatric residency doctor-patient communication skills

作　　者：王秀娟[1] 王爱华[1] 梁颖[2] 韩彤昕[3] 焦莉平[1] 王利平 吕亚奇 Wang Xiujuan;Wang Aihua;Liang Ying;Han Tongxin;Jiao Liping;Wang Liping;Lyu Yaqi(Department of Education, Beijing Children＇s Hospital, Capital Medical University ＆ National Center for Children＇s Health, Beijing 100045, China;Department of Nephrology of Beijing Children＇ s Hospital, Capital Medical University ＆ National Center for Children＇s Health, Beijing 100045, China;Department of Rheumatology and Immunology, Beijing Children ＇ s Hospital, Capital Medical University ＆ National Center for Children＇ s Health, Beijing 100045, China;Center for Clinical Epidemiology and Evidence-based Medicine, Beifing Children＇s Hospital, Capital Medical University ＆ National Center for Children＇s Health, Beijing 100045, China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院教育处,100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院肾病科,100045 [3]国家儿童医学中心首都医科大学附属北京儿童医院风湿免疫科,100045 [4]国家儿童医学中心首都医科大学附属北京儿童医院临床流行病与循证医学中心,100045

出　　处：《中华医学教育杂志》2018年第3期439-443,共5页Chinese Journal of Medical Education

基　　金：中华医学会医学教育分会和中国高等教育学会医学教育专业委员会立项课题（2016B-RW015）;首都医科大学教育教学改革校长基金项目（2016JYY186）

摘　　要：目的构建评价儿科住院医师医患沟通能力的考核评价指标体系。方法采用文献查阅及专家咨询方法，自行设计了医患沟通考核评价表。该评价表共包括6个维度24个条目。应用该评价表对首都医科大学附属北京儿童医院161名住院医师的医患沟通考核成绩进行分析，以验证评分表不同维度的内部一致性，以及9位考官的评分一致性。结果评价表中6个维度的Cronbach’s α系数均未超过0.6，其中内部一致性相对较好的维度为＂沟通效果＂（Cronbach’s α系数为0.58）。按＂是否扣分＂（分类变量）评判考官评分的一致性，即考官评分的kappa值，只有2个条目2个考场考官评分的kappa值≥0.4；＂肢体语言＂等8个条目分别有1个考场的kappa值≥0.4，其余14个条目5个考场考官评分的kappa值均〈0.4，这说明考官间一致性较差。按＂具体扣多少分＂（连续变量）评判考官间评分的一致性，其中考场D有6个条目的Cronbach’s α系数≥0.6的情况，考场C只有1项Cronbach’s α系数为0.83，并出现同考场2名考官之间评分差异较大的现象，这说明需要加强考官培训。结论需进一步优化评分表，制定具体评分标准，探索科学的医患沟通能力评价体系。ObjectiveTo construct the evaluation indicators for assessing the doctor-patient communication skills of pediatric residents.MethodsUsing literature review and expert consultation methods, summarizing a self-designed doctor-patient communication assessment form. The evaluation table includes 24 items in 6 dimensions in total. Using the evaluation table analyze the scores of doctor-patient communication assessment of 161 residents in Beijing Children’s Hospital, Capital Medical University, to verify the internal consistency of different dimensions of the score table and the consistency of the scores of the nine examiners.ResultsThe six dimensions of the Cronbach’s alpha coefficient in the evaluation table do not exceed 0.6, and the preferable dimension of internal consistency is ＂communication effect＂ （α=0.58）. According to ＂whether the points were deducted＂ （categorical variables） to judge the consistency between the examiners, only two entries kappa value of two test sites≥ 0.4, ＂body language＂ and other eight entries were a test kappa≥ 0.4, the remaining 14 The entries kappa value of 5 test sites were 〈0.4, indicating poor consistency between examiners. According to the ＂specific scores deduction＂ （continuous variable） to judge the consistency between the examiners where the examination room D has 6 entries α value≥ 0.6, C only one Cronbach coefficient α 0.83, and with the examination room two examiners There is a big difference between the score and the phenomenon, indicating the need to strengthen the examiner training.ConclusionsNeed to further optimize the score sheet, develop specific grading standards, and explore scientific evaluation system of doctor-patient communication ability.

关 键 词：儿科住院医师 人文沟通 考核评价 研究 

分 类 号：C975[经济管理—劳动经济] R-4[医药卫生]