卡尔加里-剑桥指南联合SEGUE量表在全科医师规范化培训教学改革中的应用

敬泽慧; 刘冀; 李晓平; 杨青岩; 徐英华

doi:10.16766/j.cnki.issn.1674-4152.003535

卡尔加里-剑桥指南联合SEGUE量表在全科医师规范化培训教学改革中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003535

1.
青海大学附属医院老年科，青海西宁 810000
2.
西宁市城西区文汇路社区卫生服务中心全科医学科，青海西宁 810008

基金项目:

青海省卫生健康委指导性计划课题 2021-wjzdx-58

详细信息

通讯作者:
刘冀，E-mail：Liuji999@126.com

中图分类号: R192.3 R499
计量
- 文章访问数: 254
- HTML全文浏览量: 87
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-24
- 网络出版日期: 2024-07-22

Application of Calgary-Cambridge guideline combined with SEGUE scale in the teaching reform of general practitioner standardized training

1.
Department of Geriatric, Qinghai University Affiliated Hospital, Xining, Qinghai 810000, China

摘要

摘要: 目的医患沟通能力作为提升全科医师岗位胜任力的重要能力之一，是全科医师规范化培训中的重要内容，本研究探讨卡尔加里-剑桥指南(C-CG)医患沟通模式在全科医师医患沟通教学中的应用效果，为提高全科医师医患沟通能力及人文素养提供借鉴。方法选取2021年5月—2023年5月在青海大学附属医院全科医学基地参加全科规培的30名规培医师，采用随机数表法分为实验组(n=15)及对照组(n=15)，对照组在临床工作期间仅接受传统医患沟通能力培训, 实验组接受卡尔加里-剑桥指南指导的医患沟通能力培训，应用医患沟通效果评价量表(SEGUE量表)分别在培训前和培训后3个月、6个月、9个月对2组医师进行医患沟通能力评估。结果 2组医师在接受医患沟通培训前，医患沟通能力得分差异均无统计学意义(P＞0.05)。培训后2组沟通技能成绩均较前呈显著上升趋势，且二者变化存在显著差异，随时间延长，在干预后3个月[(15.67±1.84)分 vs. (11.67±2.06)分]、6个月[(19.53±1.73)分 vs. (15.73±1.49)分]、9个月[(21.07±1.22)分 vs. (18.20±1.70)分]，这种差异更加明显；实验组在准备启动、信息收集、信息给予、理解患者、结束问诊各维度得分均显著高于对照组(P＜0.05)。结论卡尔加里-剑桥指南医患沟通模式与传统医患沟通模式相比，在医患沟通评价的各维度，包括准备启动、信息收集、信息给予、理解患者、结束问诊等方面均存在明显优势。
- 医患沟通 /
- 卡尔加里-剑桥指南 /
- 全科医师规范化培训 /
- SEGUE量表
Abstract: Objective Doctor-patient communication ability is one of the important skills to improve the competency of general practitioners, and it is also an important content in the general practice standardized training. This study aims to explore the application of Calgary-Cambridge guidelines doctor-patient communication model in the teaching of general practitioners' doctor-patient communication, so as to provide reference for improving the doctor-patient communication ability and humanistic quality. Methods A total of 30 general practitioners who underwent general practice standardized training in the Qinghai University Affiliated Hospital from May 2021 to May 2023 were selected. They were divided into experimental group (n=15) and control group (n=15) by random number table method. The control group only received the traditional doctor-patient communication skills training during the clinical work, while the experimental group received the Calgary-Cambridge guideline doctor-patient communication skills training. The doctor-patient communication effectiveness evaluation scale (SEGUE) was used to evaluate the two groups of doctors before training, 3 months, 6 months, and 9 months after training. Results There was no significant difference in the scores of doctor-patient communication skills between the two groups before the training (P > 0.05). After training, the scores of communication skills in both groups showed a significant upward trend, and there was a significant difference between the two groups. With the extension of time the difference became more obvious as the scores of communication skills in 3 months [(15.67±1.84) points vs. (11.67±2.06) points], 6 months [(19.53±1.73) points vs. (15.73±1.49) points, and 9 months (21.07±1.22) points vs. (18.20±1.70) points]. The scores of the experimental group were significantly higher than those of the control group in the aspects of preparation and initiation, information collection, information giving, understanding patients, and ending inquiry (P < 0.05). Conclusion The Calgary-Cambridge guideline doctor-patient communication model is superior to the traditional doctor-patient communication model in all dimensions of doctor-patient communication evaluation, including preparation and initiation, information collection, information giving, understanding the patients, and ending inquiry.
- Doctor-patient communication /
- Calgary-Cambridge guidelines /
- General practitioner standardized training /
- SEGUE scale

HTML全文

表 1 2组研究对象不同时间点沟通技能成绩比较(x±s，分)

Table 1. Comparison of communication skills scores between two groups of research subjects at different time points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	11.47±0.99	11.67±2.06	15.73±1.49	18.20±1.70	91.480	＜0.001
实验组	15	12.47±2.17	15.67±1.84	19.53±1.73	21.07±1.22	103.870	＜0.001
F值		2.643	31.500	41.730	28.137
P值		0.115	＜0.001	＜0.001	＜0.001
注：F_交互=5.193，P_交互=0.002；F_组间=77.280，P_组间＜0.001；F_时间=137.543，P_时间＜0.001。

下载: 导出CSV

表 2 2组研究对象不同时间点启动沟通成绩比较(x±s，分)

Table 2. Comparison of communication scores between two groups of research subjects at different time points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	1.60±0.91	2.07±0.96	2.67±0.62	3.67±0.62	19.165	＜0.001
实验组	15	1.80±1.32	3.00±1.36	3.67±0.98	4.27±0.70	18.540	＜0.001
F值		0.233	4.699	11.250	6.163
P值		0.633	0.039	0.002	0.019
注：F_交互=1.126，P_交互=0.309；F_组间=10.825，P_组间=0.003；F_时间=33.412，P_时间＜0.001。

下载: 导出CSV

表 3 2组研究对象不同时间点信息收集成绩比较(x±s，分)

Table 3. Comparison of information collection scores between two groups of research subjects at different time points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	5.87±0.83	4.53±1.13	6.93±1.22	7.53±0.99	39.157	＜0.001
实验组	15	6.27±1.03	6.20±0.77	8.07±0.88	8.33±0.82	24.628	＜0.001
F值		1.362	22.321	11.250	6.163
P值		0.253	＜0.001	0.007	0.023
注：F_交互=2.267，P_交互=0.087；F_组间=32.474，P_组间＜0.001；F_时间=45.634，P_时间＜0.001。

下载: 导出CSV

表 4 2组研究对象不同时间点信息给予成绩比较(x±s，分)

Table 4. Comparison of scores given to two groups of research subjects at different time points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	1.27±0.46	2.00±0.53	2.60±0.51	2.80±0.56	24.586	＜0.001
实验组	15	1.33±0.62	2.47±0.64	3.20±0.68	3.33±0.62	42.424	＜0.001
F值		0.113	4.699	7.560	6.137
P值		0.739	0.039	0.010	0.020
注：F_交互=1.443，P_交互=0.236；F_组间=11.513，P_组间=0.002；F_时间=64.666，P_时间＜0.001。

下载: 导出CSV

表 5 2组研究对象不同时间点理解患者成绩比较(x±s，分)

Table 5. Comparison of Patient Perceptions between Two Groups of Study Subjects at Different Time Points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	1.80±0.68	1.93±0.59	2.27±0.59	2.60±0.63	6.298	0.002
实验组	15	1.93±1.03	2.40±0.63	2.93±0.59	3.20±0.68	12.090	＜0.001
F值		0.175	4.342	9.459	6.300
P值		0.679	0.046	0.005	0.018
注：F_交互=0.790，P_交互=0.471；F_组间=20.709，P_组间＜0.001；F_时间=11.745，P_时间＜0.001。

下载: 导出CSV

表 6 2组研究对象不同时间点结束问诊成绩比较(x±s，分)

Table 6. Comparison of end of consultation scores between two groups of research subjects at different time points(x±s, points)

组别	人数	干预前	干预后3个月	干预后6个月	干预后9个月	F值	P值
对照组	15	0.93±0.59	1.13±0.52	1.27±0.46	1.60±0.51	4.287	0.014
实验组	15	1.13±0.64	1.60±0.51	1.67±0.49	1.93±0.26	5.294	0.006
F值		0.788	6.236	5.362	5.147
P值		0.382	0.019	0.028	0.031
注：F_交互=0.425，P_交互=0.736；F_组间=10.756，P_组间=0.003；F_时间=11.974，P_时间＜0.001。

下载: 导出CSV

参考文献(17)

[1]	吴家锋, 邓明, 张柠. 北京市医药分开综合改革后某医院门诊患者满意度及其影响因素[J]. 医学与社会, 2020, 33(4): 98-100, 113. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202004023.htm WU J F, DENG M, ZHANG N. Outpatient patient satisfaction and its influencing factors in a hospital after the comprehensive reform of separating medicine and medicine in Beijing[J]. Medical and Social Journal, 2020, 33(4): 98-100, 113. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202004023.htm
[2]	Rodger Charlton, 毛婧. 英国全科医疗中的医患关系(续完)[J]. 中华全科医学, 2022, 20(6): 908-909. http://www.zhqkyx.net/article/id/84c58651-11cc-48fa-812f-96180084c773 CHARLTON R, MAO J. The doctor-patient relationship in general practice in the UK (continued)[J]. Chinese Journal of General Practice, 2022, 20(6): 908-909. http://www.zhqkyx.net/article/id/84c58651-11cc-48fa-812f-96180084c773
[3]	胡清钰, 马汶桐, 孙秀娜, 等. 不同职业发展阶段医学专业人员共情能力现状及影响因素分析[J]. 医学教育研究与实践, 2023, 31(3): 363-367, 372. https://www.cnki.com.cn/Article/CJFDTOTAL-XBYX202303020.htm HU Q Y, MA W T, SUN X N, et al. Analysis of the current situation and influencing factors of empathy ability among medical professionals at different stages of career development[J]. Medical Education Research and Practice, 2023, 31(3): 363-367, 372. https://www.cnki.com.cn/Article/CJFDTOTAL-XBYX202303020.htm
[4]	程小龙, 商艳, 韩一平. 我国全科医学发展的现状与挑战[J]. 海军军医大学学报, 2023, 44(7): 773-777. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD202307017.htm CHENG X L, SHANG Y, HAN Y P. The Current Situation and Challenges of the Development of General Practitioner Medicine in China[J]. Journal of Naval Medical University, 2023, 44(7): 773-777. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD202307017.htm
[5]	邓黎黎, 廖晓阳, 伍佳, 等. 国外医患沟通模式对我国全科医生沟通技能培训的启示[J]. 中国全科医学, 2021, 24(13): 1684-1689. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202113017.htm DENG L L, LIAO X Y, WU J, et al. Inspiration of foreign doctor-patient communication models on communication skills training for general practitioners in China[J]. Chinese General Practice, 2021, 24(13): 1684-1689. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202113017.htm
[6]	庞建欣, 王永晨. 基于全科医生胜任力的医患沟通能力培训现状及对策研究[J]. 中国全科医学, 2020, 23(16): 2057-2061. doi: 10.12114/j.issn.1007-9572.2019.00.701 PANG J X, WANG Y C. Research on the current situation and countermeasures of doctor-patient communication skills training based on the competence of general practitioners[J]. Chinese General Practice, 2020, 23(16): 2057-2061. doi: 10.12114/j.issn.1007-9572.2019.00.701
[7]	周倩倩, 何慧芳, 冯文青. 基于"问、想、做、评"模式的健康教育对脑梗死患者康复期医学行为及心理弹性的影响[J]. 黑龙江医学, 2023, 47(19): 2370-2372, 2376. doi: 10.3969/j.issn.1004-5775.2023.19.019 ZHOU Q Q, HE H F, FENG W Q. The impact of health education based on the "ask, think, do, and evaluate" model on the medical behavior and psychological resilience of patients with cerebral infarction during the rehabilitation period[J]. Heilongjiang Medical Journal, 2023, 47(19): 2370-2372, 2376. doi: 10.3969/j.issn.1004-5775.2023.19.019
[8]	卢星辰, 卢海威, 林凯, 等. 医学生医患沟通能力培养重复策略应用研究[J]. 中国高等医学教育, 2019(7): 39-40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZOGU201907024.htm LU X C, LU H W, LIN K, et al. Application of repetitive strategies in cultivating doctor-patient communication skills among medical students[J]. Chinese Higher Medical Education, 2019(7): 39-40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZOGU201907024.htm
[9]	许晓敏. 大健康背景下临床医学实习生人文素质培养的实践与探索[J]. 浙江临床医学, 2023, 25(6): 946-948. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202306055.htm XU X M. Practice and exploration of humanistic quality training of clinical medical interns under the background of general health[J]. Zhejiang Clinical Medical Journal, 2023, 25(6): 946-948. https://www.cnki.com.cn/Article/CJFDTOTAL-LICX202306055.htm
[10]	KAPOOR A, KAPOOR A, BADYAL D K. Simulated patients for competency-based undergraduate medical education post COVID-19: a new normal in India[J]. Indian Pediatr, 2021, 58(9): 881-887. doi: 10.1007/s13312-021-2312-5
[11]	刘雪寒, 鲁春丽, 郑偌祥, 等. 国内外医患沟通模式研究进展[J]. 中国医学伦理学, 2021, 34(6): 686-691. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX202106008.htm LIU X H, LU C L, ZHENG R X, et al. Research progress on doctor-patient communication models at home and abroad[J]. Chinese Medical Ethics, 2021, 34(6): 686-691. https://www.cnki.com.cn/Article/CJFDTOTAL-XNLX202106008.htm
[12]	彭涛, 汤镇海, 邹川, 等. 全科医师规范化培训中医患沟通现状调查[J]. 中华全科医学, 2022, 20(1): 134-137, 168. doi: 10.16766/j.cnki.issn.1674-4152.002295 PENG T, TANG Z H, ZOU C, et al. Investigation on the Status of Traditional Chinese Medicine Patient Communication in Standardized Training for General Practitioners[J]. Chinese Journal of General Practice, 2022, 20(1): 134-137, 168. doi: 10.16766/j.cnki.issn.1674-4152.002295
[13]	龙彦霖. 医生视角下的医患沟通影响因素研究[D]. 广州: 广东外语外贸大学, 2022. LONG Y L. Research on the Factors Influencing doctor-patient Communication from the Perspective of Doctors[D]. Guangdong: Guangdong University of Foreign Studies and Trade, 2022.
[14]	杨欣瑶. 社会临场感理论视角下在线医患沟通效果研究[D]. 上海: 上海外国语大学, 2023. YANG X Y. Research on the effectiveness of online doctor-patient communication from the perspective of social presence theory[D]. Shanghai: Shanghai Foreign Studies University, 2023.
[15]	朱文叶, 李敏, 罗壮, 等. 卡尔加里-剑桥指南联合LCSAS量表在医学生医患沟通技能培训中的应用[J]. 继续医学教育, 2019, 33(5): 32-34. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJY201905019.htm ZHU W Y, LI M, LUO Z, et al. The application of the Calgary Cambridge Guidelines combined with the LCSAS scale in training doctor-patient communication skills for medical students[J]. Continuing Medical Education, 2019, 33(5): 32-34. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJY201905019.htm
[16]	辛洪玉. 卡尔加里-剑桥指南联合案例教学在《社区护理学》课程中的应用价值[J]. 中国基层医药, 2019, 26(14): 1773-1775. doi: 10.3760/cma.j.issn.1008-6706.2019.14.030 XIN H Y. The Application Value of the Calgary Cambridge Guidelines Combined Case Teaching in the Course of Community Nursing[J]. Chinese Journal of Grassroots Medicine, 2019, 26(14): 1773-1775. doi: 10.3760/cma.j.issn.1008-6706.2019.14.030
[17]	王雪花, Jonathan Silverman, Suzanne Kurtz, 等. 医患沟通技巧: Calgary-Cambridge指南沟通过程技巧[J]. 中国医学人文, 2018, 4(8): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202308016.htm WANG X H, Jonathan Silverman, Suzanne Kurtz, et al. Communication Skills between Doctors and Patients: The Calgary Cambridge Guidelines for Communication Process Skills[J]. Chinese Journal of Medical Humanities, 2018, 4(8): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JXUY202308016.htm