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

摘要

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 different 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 effectiveness 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 probability method (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％ residents 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 increased.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 communication skill training program might be needed in the future.%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-患病方式及卡尔加里-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(α=0.05),以Pearson x2检验计算规培前后所有医师应用病史采集方式的差异(α=0.05).结果 规培前19.8％的医师应用无效沟通方式采集病史,53.0％应用传统方式采集病史,使用疾病-患病方式和卡尔加里-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-患病方式,而应用卡尔加里-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.