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中国全科医学 ›› 2021, Vol. 24 ›› Issue (5): 614-618.DOI: 10.12114/j.issn.1007-9572.2021.00.076

• 专题研究 • 上一篇    下一篇

我国医学生医患沟通能力住院患者评价量表的编制及信效度检验

刘江华1，李骄阳1，封恬恬2，文兰3，唐艳4，苏玲5*，陈国栋6*   

  1. 1.421001湖南省衡阳市，南华大学附属第一医院内分泌代谢科　2.421001湖南省衡阳市，南华大学附属第一医院教育培训部　3.421001湖南省衡阳市，南华大学附属第一医院人文教研室　4.421001湖南省衡阳市，南华大学附属第一医院心血管内科　5.421001湖南省衡阳市，南华大学马克思主义学院　6.421001湖南省衡阳市，南华大学附属第一医院肝胆胰外科
    *通信作者：苏玲，教授；E-mail：chinajyxdh@163.com　陈国栋，副教授；E-mail：chenguodongusc@126.com
  • 出版日期:2021-02-15 发布日期:2021-02-15
  • 基金资助:
    基金项目：全国教育科学“十三五”规划课题（BIA170177）；湖南省教育科学“十三五”规划课题（ XJK17BGD064）；湖南省哲学社会科学基金项目（15YBA322）；湖南省普通高等学校教学改革研究项目（湘教通［2015］291号-239）；湖南省卫生计生委科研基金（B2017052）；湖南省普通高等学校教学改革研究项目（湘教通［2018］436号-350）；湖南省学位与研究生教育教学改革研究项目（JG2018B093）

Development，Reliability and Validity of Chinese Medical Students' Doctor-patient Communication Skills Scale Evaluated by Inpatients　

LIU Jianghua1，LI Jiaoyang1，FENG Tiantian2，WEN Lan3，TANG Yan4，SU Ling5*，CHEN Guodong6*   

  1. 1.Department of Endocrinology and Metabolism，the First Affiliated Hospital of University of South China，Hengyang 421001，China
    2.Department of Education and Training，the First Affiliated Hospital of University of South China，Hengyang 421001，China
    3.Humanities Teaching and Research Department，the First Affiliated Hospital of University of South China，Hengyang 421001，China
    4.Department of Cardiology，the First Affiliated Hospital of University of South China，Hengyang 421001，China
    5.Academy of Marxism，University of South China，Hengyang 421001，China
    6.Department of Hepatopancreatobiliary Surgery，the First Affiliated Hospital of University of South China，Hengyang 421001，China
    *Corresponding authors：SU Ling，Professor；E-mail：chinajyxdh@163.com
    CHEN Guodong，Associate professor；E-mail：chenguodongusc@126.com
  • Published:2021-02-15 Online:2021-02-15

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摘要： 背景　目前我国对医学生医患沟通能力的评价研究甚少且存在较大的局限性，不能客观、准确、全面地检测医学生的医患沟通能力并及时给予反馈。目的　编制医学生医患沟通能力住院患者评价量表，并对其进行信效度检验。方法　采用整群抽样的方法选择南华大学附属第一医院2018年10月和11月参加出科考试的448名住院医师规范化培训生（住培生）为调查对象，通过文献查阅、研究小组讨论、专家论证及小样本预调查形成医学生医患沟通能力住院患者评价量表初稿，模拟住院患者入院至出院情景，以住院患者为评价者，对住培生的医患沟通能力进行测评。运用决断值（CR值）、相关系数、克朗巴赫α系数及探索性因子分析进行条目筛选，形成医学生医患沟通能力住院患者评价量表，并检验量表的同质信度、分半信度、组合信度、同时效度、结构效度，采用验证性因子分析〔近似均方根残差（RMSEA）、拟合优度指数（GFI）、标准拟合指数（NFI）、相比较拟合指数（CFI）、对拟合指数（RFI）〕检验量表的结构合理性。结果　本次研究共发放量表448份，回收有效量表395份，其中10月份176份，11月份219份。通过条目筛选和探索性因子分析，形成了含沟通态度、疾病了解、病情告知、沟通效果、病史采集、诊治解释6个维度24个条目的医学生医患沟通能力住院患者评价量表，其克朗巴赫α系数为0.863，分半信度为0.716，各维度的组合信度为0.766~0.837；6个维度与量表总分的相关系数为0.639~0.791。验证性因子分析结果显示，RMSEA为0.050，GFI为0.837、NFI为0.872、CFI为0.835、RFI为0.819。结论　医学生医患沟通能力住院患者评价量表具有良好的信效度，值得进一步推广。

关键词: 医生病人关系, 医患沟通, 医学生, 量表编制, 信度, 效度

Abstract: Background　At present，domestic studies about Chinese medical students' doctor-patient communication skills are rare and have many limitations，which are hard to offer medical students an objective and accurate assessment，as well as to provide a feedback in time.Objective　To develop a Chinese medical students' doctor-patient communication skills scale evaluated by inpatients，and to test its reliability as well as validity.Methods　During October to November，2018，448 resident doctors who underwent standardized training and took after-department examination in the First Affiliated Hospital of University of South China were selected through cluster sampling.The beta scale was built through literature review，panel discussion，expert argumentations and preliminary tests，during the simulated process from inpatients' hospitalization to hospital discharge，and inpatients were invited to assess resident doctors' doctor-patient communication skills.Then，items were screened through calculating the critical ratio，correlation coefficient，and Cronbach's α and exploratory factor analysis to develop the formal scale.We also assessed homogeneity reliability，split-half reliability，composite reliability，concurrent validity，construct validity，tested the structure rationality by confirmatory factor analysis of RMSEA，GFI，NFI，CFI，and RFI.Results　395 out of 448 samples were valid（176 were collected in October and the rest 219 in November）.Through item selections and exploratory factory analysis，the formal scale concluded 6 dimensions（communication attitude，understanding of diseases，disease informing，communication effectiveness，obtaining medical histories，diagnosis and treatment explanation）and 24 items.Cronbach's α coefficient of the formal scale was 0.863，split-half reliability was 0.716，and composite reliability of the 6 dimensions were within 0.766-0.837，the correlation coefficients between the 6 dimensions and the total scale were within 0.639
-0.791.The results of the confirmatory factor analysis showed：RMSEA was 0.050，GFI was 0.837，NFI was 0.872，CFI was 0.835，and RFI was 0.819.Conclusion　The inpatient-evaluation scale of Chinese medical students' doctor-patient communication skills has been proved to be reliable and valid and is worthy of popularization and application.

Key words: Doctor-patient relations, Doctor-patient communication, Medical students, Scaling, Reliability, Validity

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