Special Issue: Doctor-patient Communication

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1. Development, Reliability and Validity of the Five Habits Coding Scale

Qingyan WANG, Lanyi YIN, Yaxin YAN, Yan PENG, Chenjiao YAO, Qiuping TANG, Xinchun LIU

Chinese General Practice 2022, 25 (16): 1990-1994. DOI: 10.12114/j.issn.1007-9572.2022.0135

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Background

Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.

Objective

To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.

Methods

The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.

Results

The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .

Conclusion

The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.

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2. Enlightenment of Foreign Doctor-patient Communication Models to Relevant Trainings for General Practitioners in China　

DENG Lili, LIAO Xiaoyang, WU Jia, XIONG Mei

Chinese General Practice 2021, 24 (13): 1684-1689. DOI: 10.12114/j.issn.1007-9572.2021.00.185

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Skills for communicating with patients are one kind of core ability that general practitioners（GPs） must possess，ensuring the improvement of services quality provided by GPs. The systematic，simple and practical doctor-patient communication models developed by foreign countries based on a large amount of research experience have been widely used in medical education，and proved to be crucial for improving doctors' skills for communicating with patients.In contrast，in China，GPs show relatively poor abilities in communicating with patients，which may be caused by insufficient awareness of training this ability in medical students influenced by the traditional biomedical model，and unsatisfied quality of such trainings due to lack of relevant teaching materials for medical students with different majors at different learning stages，and lack of relevant theoretical studies. As systematic，simple，and practical curriculum is the key to ensure the quality of training GPs' skills for communicating with patients，we detailedly analyzed the recommended major doctor-patient communication models in foreign countries（patient-centered communication，Calgary-Cambridge Guide，SEGUE Framework，Four Habits Model，Kalamazoo Essential Elements communication Checklist-Adapted），aiming at providing a reference for developing course contents of doctor-patient communication skills for GPs in China.

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3. Doctor-patient Communication Skills in Master Supervisors in General Practice during Outpatient Encounters: a Survey from Beijing

ZHAO Tiefu, ZHANG Bin, MA Hanying, HAN Hongya, MA Liping, GAO Xuxia, LUO Tianxiang, LUO Hongchi

Chinese General Practice 2023, 26 (28): 3539-3543. DOI: 10.12114/j.issn.1007-9572.2022.0637

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Background

Graduate supervisors in general practice are responsible for the important task of training future general practice professionals, so their abilities to communicate with patients are essential for the development of general practice.

Objective

To examine the abilities to communicate with patients in supervisors of master's students in general practice during outpatient encounters.

Methods

Seventy-five supervisors of master's students in general practice from Capital Medical University were selected by use of cluster sampling to receive a survey using a self-developed demographic questionnaire conducted from April to June 2022. Then their doctor-patient communication skills during outpatient encounters were assessed by relevant professionals who participated in the whole encounter process as accompaniers using the SEGUE Framework. The total score and dimension scores of SEGUE Framework of these supervisors were compared with those of outpatient specialists in tertiary hospitals and general practitioners (GPs) in community health centers (CHCs) in our previous studies, and were compared across these supervisors by sex, employment method and level of medical institutions. Then the total score of SEGUE Framework was compared between the supervisors and US GPs.

Results

The total score of SEGUE Framework attained by the supervisors ranged from 12 to 24 points, and the average score was (17.8±2.6) . The average scores of five dimensions (set the stage, elicit information, give information, understand the patient's perspective, and end the encounter) obtained by them were (3.9±0.9) , (6.5±1.7) , (3.1±1.1) , (2.6±0.9) and (1.7±0.5) , respectively. These supervisors scored higher on dimensions of set the stage and end the encounter than GPs in CHCs and outpatient specialists in tertiary hospitals (P<0.05) . Compared with their counterparts working in primary hospitals, supervisors working in secondary hospitals scored lower on the SEGUE Framework and set the stage dimension (P<0.05) , and those working in tertiary hospitals scored lower on the SEGUE Framework and set the stage and elicit information dimensions (P<0.05) . These supervisor scored lower on the SEGUE Framework than the US GPs (P<0.05) .

Conclusion

There is still considerable room for improvement of the skills for communicating with patients in outpatient encounters in these supervisors. Their level of communication skills was still lower than that of US GPs. In view of this, the teaching management department responsible for general practice department (school) should pay attention to the training of the abilities of master supervisors to communicate with patients, thereby improving the level of medical humanities in practice in master's students in general practice by supervisors' words and deeds.

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

LIU Jianghua，LI Jiaoyang，FENG Tiantian，WEN Lan，TANG Yan，SU Ling，CHEN Guodong

Chinese General Practice 2021, 24 (5): 614-618. DOI: 10.12114/j.issn.1007-9572.2021.00.076

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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.

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5. Effect of ISBAR Communication Training Model on Communication Skills and Teamwork Ability of General Practitioners Participating in Standardized Residency Training　

CAO Meng，WANG Tao，ZHAI Qianqian，QIN Yan

Chinese General Practice 2020, 23 (16): 2062-2066. DOI: 10.12114/j.issn.1007-9572.2019.00.700

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Background　One of the training objectives of the Standardized Residency Training is good communication and cooperation，so it is of great importance to improve the communication awareness and skills and teamwork ability of residents participating in the Standardized Residency Training.ISBAR communication training model has been proved that it could effectively improve the communication skills and teamwork ability of doctors in clinical settings，so it is theoretically feasible to apply this communication training model to the Standardized Residency Training.Objective　To explore the effect of ISBAR communication training model on the interpersonal communication skills and teamwork ability of general practitioners participating in the Standardized Residency Training.Methods　A total of 100 general practitioners who participated in the Standardized Residency Training in the First Affiliated Hospital of Xinxiang Medical University in September 2017 were randomly selected and divided into observation group（n=50） and control group（n=50） by simple random grouping method.General practitioners in the control group were trained by traditional clinical education model，whereas based on this model general practitioners in observation group were also trained by ISBAR communication training model.The Interpersonal Communication Ability Evaluation Scale and Teamwork Ability Evaluation Scale were used to assess general practitioners in the two groups before and after two weeks of training.The Attitudes towards Cooperation between Doctors and Nurses Scale and Attitudes towards Cooperation among Doctors Scale were used to assess general practitioners in the two groups before and after three and six months of training.The Interpersonal Communication Ability between Doctors and Nurses Questionnaire and Interpersonal Communication Ability among Doctors Questionnaire were used to survey the medical workers who cooperated with the general practitioners in two groups.Results　There were no statistical differences in the scores of interpersonal communication ability and teamwork ability between two groups before the training（P>0.05）.After two weeks of training，the scores of interpersonal communication ability and teamwork ability in both two groups were higher than those before the training（P<0.05），and the scores of interpersonal communication ability and teamwork ability in the observation group were higher than those in the control group（P<0.05）.There were significant differences in the scores of attitudes towards cooperation and communication ability between doctors and nurses（P<0.05）.The differences were statistically significant at different time points（P<0.05）.Groups and time had notable interaction effect on the scores of attitudes towards cooperation and communication ability between doctors and nurses（P<0.05）.There were significant differences in the scores of attitudes towards cooperation and communication ability among doctors（P<0.05）.The differences were statistically significant at different time points（P<0.05）.Groups and time had notable interaction effect on the scores of attitudes towards cooperation and communication ability among doctors（P<0.05）.Conclusion　Applying ISBAR communication training model during the Standardized Residency Training may significantly improve the interpersonal communication skills and teamwork ability of general practitioners.

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6. Current Situation of Doctor-patient Communication Competence Training Based on the Post Competency of General Practitioners and Corresponding Countermeasures　

PANG Jianxin，WANG Yongchen

Chinese General Practice 2020, 23 (16): 2057-2061. DOI: 10.12114/j.issn.1007-9572.2019.00.701

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Doctor-patient communication competence is the essential quality of general practitioners（GPs）.Good communication between doctors and patients is not only the basis of patients' trust but also an important guarantee for the smooth implementation of GPs' community health service.At present，the influence of communication competence on doctor-patient relationship has attracted more and more attention and the training for doctor-patient communication competence has become one research focus.However，the increasingly tension of doctor-patient relationship indicates that the communication between doctors and patients is still not satisfactory.Therefore，this paper illustrates the current situation of training for doctor-patient communication competence at home and abroad，and emphasizes the necessity of improving the doctor-patient communication competence among GPs.Moreover，this paper draws on relevant foreign experience to explore concrete measures to improve the doctor-patient communication competence of GPs，such as setting up communication courses，applying various training forms，and strengthening the assessment of doctor-patient communication competence，in order to provide the theoretical reference for the education and training of doctor-patient communication competence of GPs in China.

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7. Design and Development of Communication Skills Training in Diabetes Care for General Practitioners in China

YAO Mi, LIN Kai, FAN Jieting, JI Xinxin, WANG Ying, DONG Aimei, HAN Xiaoning, QI Jianguang, CHI Chunhua, Haroon Shamil, Jackson Dawn, Cheng KK, Lehman Richard

Chinese General Practice 2024, 27 (07): 816-821. DOI: 10.12114/j.issn.1007-9572.2022.0900

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General practitioners (GPs) play an important role in diabetes care in primary care as the "gatekeepers" of population health. The management of diabetes can slow its progression, reduce complications and improve patient outcomes, which requires effective communication and collaboration between patients and their doctors. GPs with good communication skills can help to build long-term care relationships with diabetes patients and help them develop effective self-management skills. This paper summarizes the design and development of diabetes communication skills training for GPs guided by research team with multiple theoretical frameworks, including evidence-based findings from systematic review, experiences and ideas of diabetes patients communicating with GPs based on qualitative studies, prioritization of training content for patient-doctor communication in GPs captured by mixed-methods research, in order to provide new ideas for high-quality diabetes management in primary care and inform the design of training programmes for GPs based on evidence and medical education frameworks.

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8. 医学生人际沟通能力评价量表的编制

王伟，尹文强

Chinese General Practice 2015, 18 (22): 2709-2712. DOI: 10.3969/j.issn.1007-9572.2015.22.021

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目的编制医学生人际沟通能力评价量表，为评价医学生沟通能力提供工具。方法 2011年12月-2013年12月，通过广泛查阅国内外相关文献资料，参考国内外关于沟通能力的理论研究，借鉴相关量表，运用专家小组讨论和小范围测试构建维度和条目，并在潍坊医学院的502例医学生中采用临界比值法、Cronbach′s α、主成分分析法进行量表的项目分析和信、效度评价。结果医学生人际沟通能力评价量表构成包括5个维度33个条目，各条目比较可靠，量表的Cronbach′s α=0.962，KMO=0.97。结论该量表具有较好的信度和效度，可用于评价医学生的沟通能力。

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9. Training Needs and Influencing Factors of General Practitioners' Communication Skills under the Synergy of Health Care System and Medical Educational System　

DENG Lili，LIAO Xiaoyang，ZOU Chuan，WU Jia，CHENG Chunyan，ZHAO Qian，WANG Lifei，LUO Xiaolu

Chinese General Practice 2021, 24 (13): 1690-1696. DOI: 10.12114/j.issn.1007-9572.2021.00.018

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Background　The synergy of health care system and medical educational system aims to foster healthcare talents with a priority on general practitioners（GPs），which is a key to improving health care. Communication skills are one of the core competencies that GPs must master. Although China has opened doctor-patient communication training courses for GPs，the training effect is poor. Studies have demonstrated that the demand-oriented training model may quickly meet the clinical needs and significantly improve the quality of teaching. Objective　To explore the training needs and influencing factors of GPs under the synergy of health care system and medical educational system. Methods　By use of cluster sampling，we selected the community base of West China Hospital-community consortium for standardized training for GPs in October 2018，and invited 104 GPs from all the 12 community health centers in the consortium to participate in a structured questionnaire survey for collecting their demographic characteristics，perceived importance of doctor-patient communication，previous trainings of doctor-patient communication，needs of related trainings and intention to attend such trainings，and perceived influencing factors for doctor-patient communication. Binary logistic regression analysis was used to analyze the influencing factors associated with training needs of communication skills. Results　The survey achieved a 100.0% response rate. Among the respondents，95.2%（99/104）believed that doctor-patient communication was important，and 66.3%（69/104）had attended trainings in doctor-patient communication. The top topic that 82.6%（57/69）of participants had been trained was "building a healthy relationship"，the bottom was "empathy training" with 29.0%（20/69）. All the respondents had the training needs for communication. The top topic that 71.8%（61/85） of participants would like to be trained was "shared decisions making"，and the bottom was "history taking" with 16.4%（17/104）. Binary logistic regression analysis found that training needs was influenced by gender，age，education level，previous training experience，self-rated communication skills and doctor-patient relationship satisfaction（P<0.05）. The commonest barrier to doctor-patient communication was "lack of time and energy due to busy work"，followed by "lack of skills to effectively communicate with patients". Conclusion　Under the synergy of health care system and medical educational system，the GPs attached great importance to doctor-patient communication，and demonstrated strong training needs and willingness. There are differences between previous training contents and training needs. Continuous and dynamic assessment of training needs is the key to ensuring the quality of such trainings for GPs.

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10. Effect of Marital Communication Patterns on Depression：a Comparison between Clinical and General Population Samples　

LI Qiang1，2，JIN Ling1，2，CHEN Chen1，2，ZHOU Yi-xin1，2，ZHOU Ming-jie1，2*

Chinese General Practice 2018, 21 (13): 1618-1623. DOI: 10.3969/j.issn.1007-9572.2018.13.022

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Objective　To explore the relationship between marital communication patterns and depression in a clinical sample versus a general sample.Methods　This study was conducted between two samples recruited in 2016，including 148 outpatients with marriage problems from a mental health hospital in Beijing（clinical group），and 400 normal married participants（control group）.A self-developed Demographic Questionnaire，Chinese version of PHQ-9（PHQ-9-C）and Chinese version of CPQ-SF（CPQ-SF-C）were used to measure the demographic information，depression and communication patterns of the participants.Hierarchical regression analysis was used to examine the moderate effect of different types of samples on the relationship between marital communication patterns and depression.Results　（1）Compared with the control group，clinical group scored higher in depression，male demand/female withdraw，female demand/male withdraw，total demand/ withdraw and criticize/defend，but scored lower in constructive communication （P<0.05）.（2）Two groups achieved similar scores in alternative demand/ withdraw（P>0.05）.（3） Hierarchical regression analysis showed that，male demand/ female withdraw，female demand/male withdraw，total demand/withdraw，alternative demand/withdraw，criticize/ defend could positively predict depression（P<0.05），when gender，educational attainment，and if the participant has a child were controlled，while constructive communication could negatively predict depression （P<0.05）.（4） After bringing the product terms of male demand/female withdraw，female demand/ male withdraw，total demand/ withdraw，alternative demand/withdraw criticize/ defend，constructive communication with sample type into the regression model，respectively，the results demonstrated that the interaction between male demand/ female withdraw and sample type，as well as that between constructive communication and sample type were significant（P<0.05）.The type of the sample played a moderate role in the relationship between male demand/female withdraw and depression，and the relationship between constructive communication pattern and depression（△R2=0.011，P<0.05；△R2=0.019，P<0.05）.Conclusion　Sample type plays a moderating role in the relationship between marital communication pattern and depression，especially in the relationship between male demand/female withdraw and depression，as well as that between constructive communication pattern and depression.

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11. "Patients-centered" in the Reform of Public Primary Health Care Institutions: Does Doctor-patient Communication Improve the Quality of Primary Care Services?

LI Dongxu, SU Min, LIU Bin, ZHANG Tianjiao, ZHANG Weile

Chinese General Practice 2023, 26 (31): 3847-3855. DOI: 10.12114/j.issn.1007-9572.2023.0089

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Background

The concept of "patients-centered" has presented higher requirements doctor-patient communication and reconstructing doctor-patient relationship in public primary health care institutions.

Objective

To analyze the impact of "patients-centered" doctor-patient communication on the quality of primary care services, and provide scientific evidence to promote reforms in public primary health care institutions.

Methods

All public community health centers providing primary care services in the main urban area of a city in Inner Mongolia Autonomous Region were selected as the study sites to conduct a field survey in 2021 using the standardized patient method, which included 118 items of doctor-patient communication data involving 26 medical institutions, 59 doctors, and 12 standardized patients. Common cold, asthma, and unstable angina were selected as the types of diseases to be portrayed by the standardized patients in this study. A combination of multiple regression model and Probit model was used to evaluate the impact of "patients-centered" doctor-patient communication on the quality of primary care services.

Results

Results obtained from the 118 items of doctor-patient communication data revealed that the median adherence rate for recommended consultation items was 17.6% (14.6%), and the median adherence rate for recommended examination items was 25.0% (40.0%), among them, 75 cases (63.6%) were correctly diagnosed, and 59 cases (50.0%) were correctly treated. The median total cost was 84.84 yuan (130.44 yuan), and the median drug cost was 37.62 yuan (47.38 yuan), among them, 66 (55.9%) involved unnecessary drugs, and 71 (60.2%) included unnecessary examinations. The median visit duration was 13.625 (10.850) min. The average score for "patients-centered" doctor-patient communication was (26.712±10.658), with the first dimension scoring (12.915±5.355) points, the second dimension scoring (7.492±2.867) points, and the third dimension scoring (6.305±3.465) points. The results of multiple linear regression model and Probit model indicated that for every one-point increase in the total score of patient-centered doctor-patient communication, the adherence rates for both recommended consultation items and recommended examinations items increased by 0.001 percentage points, the correct diagnosis rate increased by an average of 4.6 percentage points, the correct treatment rate increased by 4.2 percentage points, the total cost increased by 1.993 yuan, the drug cost increased by 0.517 yuan, the proportion of unnecessary drugs decreased by 3.4 percentage points, the proportion of unnecessary examinations increased by 0.2 percentage points, and the visit duration decreased by 0.291 minutes.

Conclusion

"Patients-centered" doctor-patient communication enhances the effectiveness and safety of medical services, while it also increases medical costs. It is necessary to promote "patients-centered" doctor-patient communication from the aspects of resource endowment, salary incentives, doctor-patient relationships, and collaborative services, thereby improving the quality of primary care services.

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12. General Practitioner-patient Communications in Outpatient Clinic Settings in Beijing

ZHAO Tiefu，ZOU Xiaozhao，ZHOU Hongdan，MA Hanying

Chinese General Practice 2019, 22 (4): 413-416. DOI: 10.12114/j.issn.1007-9572.2019.04.009

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Background　General practitioners（GPs） are the main providers of community health services and gatekeepers of residents' health.For them，mastery of doctor-patient communication skills is particularly important.Objective　To evaluate the communication skills of GPs when they interact with patients in community health centers（CHCs） of Beijing.Methods　Using convenience sampling，60 out of 77 national and municipal community health demonstration centers recommended by Beijing Community Health Service Network were selected，from which 300 doctors in outpatient clinic settings were selected by accidental sampling（5 from each center）．The survey was conducted from January 2017 to March 2018.The assessors entered the clinic with the patients and their families.The doctor-patient communication skills were observed on-site and assessed by the SEGUE Framework.Results　The total SEGUE score of the GPs ranged 6-22，with an average score of （16.0±6.3）；the mean scores of 5 stages of set the stage，elicit information，give information，understand the patient's perspective and end the encounter were was （3.9±1.9）（6.4±2.1）（3.0±1.7）（2.7±1.5）（1.8±0.4），respectively.Compared with the physicians and specialists in outpatient clinic settings of tertiary grade A hospitals in Beijing who received the same assessment during this period，GPs in outpatient clinic settings of CHCs had much higher mean scores of set the stage（P<0.05）．Compared with the general physicians in outpatient clinic settings of tertiary grade A hospitals，GPs in outpatient clinic settings of CHCs obtained significantly higher mean scores in 3 stages of set the stage，elicit information，and end the encounter and higher mean total SEGUE score （P<0.05）．However，both these GPs from CHCs and the physicians from tertiary grade A hospitals achieved lower total SEGUE scores than the American general physicians（P<0.05）．Conclusion　In Beijing，only the score of set the stage of GPs in CHCs is higher than those of physicians in outpatient clinic settings of tertiary grade A hospitals，but are lower than those of international counterparts.GPs are suggested to improve their clinical communication skills further.

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13. 医学生沟通能力现状及其影响因素调查研究

唐梦琦，尹文强，马牧野，曹海虹，谭晖，陈钟鸣，贾海艺，朱丽丽，王伟

Chinese General Practice 2016, 19 (20): 2464-2468. DOI: 10.3969/j.issn.1007-9572.2016.20.022

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目的了解医学生沟通能力现状，并探讨其影响因素。方法于2013年10月-2014年1月，采用多阶段分层随机抽样方法，对山东省3所医学院校5个年级共1 600例医学生进行问卷调查，包括一般资料调查表、淡路向性检验卡、医患认知及沟通知识状况问卷、人际沟通能力测评量表。分别调查医学生对医患关系认知与医学生沟通知识状况、评价医学生沟通能力得分、医学生内外向性格特征。根据医学生沟通能力得分，以得分达到总分的80%及以上者为绩优组，以得分低于总分的80%者为绩平组。分析影响医学生沟通能力现状的因素。结果共发放调查问卷1 600份，回收1 460份，有效问卷1 381份，有效回收率为86.3%。1 381例医学生中，性格类型为外向型者455例（32.9%），中间型者598例（43.3%），内向型者328例（23.8%）；认为医患关系会趋好者612例（44.3%），认为变化情况不一定者551例（39.9%），认为会趋坏者218例（15.8%）。医学生沟通能力平均得分为（115.9±20.1）分，沟通能力绩优组254例，平均得分为（142.7±10.0）分；绩平组1 127例，平均得分为（109.7±16.5）分。不同性别、年级医学生的沟通能力比较，差异无统计学意义（P＞0.05）；不同生源地、是否为独生子女、性格类型、是否担任学生干部、家庭氛围、家庭经济状况、是否参加医患沟通课程以及不同医患关系态度医学生的沟通能力比较，差异均有统计学意义（P＜0.05）。多因素逐步Logistic回归分析结果显示，性格类型、学生干部、家庭氛围、家庭经济状况、医患沟通课程、医患关系态度是医学生沟通能力的影响因素（P＜0.05）。重要性象限图结果显示，家庭氛围和家庭经济状况属于Ⅱ区，重要程度较高，但得分较低；性格类型和是否参加医患沟通课程属于Ⅳ区，重要程度和得分均较高，应继续维持。结论医学生沟通能力整体水平较低，性格类型、是否为学生干部、家庭氛围、家庭经济状况、医患沟通课程和医患关系态度是影响医学生沟通能力的主要因素。可通过增强医学生自信心锻炼，增加医学生与他人沟通交流的机会，营造和谐的家庭氛围，医学院校规范开设医患沟通课程等措施，促进医学生沟通能力提升。

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14. 基于SEGUE量表的医生医患沟通技能评价研究

申丽君1，孙刚2*

Chinese General Practice 2017, 20 (16): 1998-2002. DOI: 10.3969/j.issn.1007-9572.2017.16.019

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目的了解医生的医患沟通技能，探讨问诊流程中的薄弱环节并提出相应对策。方法于2016年4-5月在广州市某三级甲等医院选取就诊患者320例进行问卷调查，内容包括人口学资料、医患沟通基本问题、医患沟通技能评价量表（SEGUE量表）3部分，其中SEGUE量表包括准备阶段、信息收集、信息给予、理解患者、结束问诊5个维度共25个条目。同期在该院选取就诊患者31例进行访谈，整理并分析医患沟通过程中普遍存在的问题,以为研究的讨论和建议部分提供补充说明。结果共发放问卷320份，回收有效问卷311份，问卷有效回收率为97.2%。患者的SEGUE量表平均评分为（15.5±5.2）分，准备阶段、信息收集、信息给予、理解患者、结束问诊维度的平均评分分别为（2.8±1.3）、（6.5±2.2）、（2.6±1.2）、（2.4±1.3）、（1.3±0.8）分，得分率分别为56.6%（176/311）、64.5%（201/311）、64.8%（202/311）、60.0%（187/311）、64.0%（199/311）。不同文化程度患者总量表及信息给予、理解患者维度评分比较，差异有统计学意义（P＜0.05）；准备阶段、信息收集、结束问诊维度评分比较，差异无统计学意义（P＞0.05）。对沟通感到非常满意、满意、一般、不满意的患者例数分别为9例（2.9%）、104例（33.4%）、166例（53.4%）、32例（10.3%）。不同沟通满意度患者在礼貌称呼、询问问诊理由、介绍问诊和查体过程、建立个人信任关系、保护隐私、系统询问社会/心理因素、讨论既往治疗经过、疾病对生活的影响、健康的生活方式、避免强硬方式或诱导性方式提问、留有说话时间和机会、医生用心倾听说话、核实所获得信息、解释诊断性操作的理论依据、告诉患者目前身体情况、鼓励患者提问和核实自己的理解、根据患者理解力进行适当调整、认同患者的付出或取得的成就、保持尊重语气、表达关心/关注、询问患者是否有其他问题讨论、进一步说明下一步诊治方案22个条目的得分率比较，差异有统计学意义（P＜0.05）；在讲诉对健康问题的看法、系统询问生理/物理因素、体察患者暗示并配合3个条目的得分率比较，差异无统计学意义（P＞0.05）。有序多分类Logistic回归分析结果显示，礼貌称呼、建立个人信任关系、避免强硬方式或诱导性方式提问、医生用心倾听说话、保持尊重语气是患者沟通满意度的影响因素（P＜0.05）。结论患者对医生的医患沟通技能评分偏低，尤其是准备阶段、理解患者2个维度，学历较高患者对医生沟通技能要求较高。接诊过程中，礼貌称呼、建立个人信任关系、避免强硬方式或诱导性方式提问、医生用心倾听说话、保持尊重语气是患者沟通满意度的影响因素。

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15. SBAR Communication Technique for Reducing Relocation Stress among Elderly People Newly Admitted to Nursing Homes

WANG Zhen-zhen1，TANG Lang-juan2*，TU Shu-hua3

Chinese General Practice 2018, 21 (14): 1661-1665. DOI: 10.3969/j.issn.1007-9572.2018.00.134

Abstract （448）

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Objective　To explore the effect of SBAR communication technique on reducing the relocation stress among elderly people newly admitted to nursing homes.Methods　The enrolled participants were 118 elderly people newly admitted to a nursing home in Nanchang，57 of them treated with the conventional reception between April and September 2016 were assigned to the control group，and other 61 treated with the SBAR communication technique-based reception between March and August 2017 were assigned to the observation group.The Chinese version of 15-item Geriatric Depression Scale（C-GDS-15） was used to assess the depression status.The Chinese version of Stress Response Questionnaire（C-SRQ） was employed to evaluate the status of relocation stress.The symptoms of relocation stress occurred within a short period after admission were compared between the groups.Results　Compared with the controls，patients treated with SBAR communication technique-based reception were less likely to have symptoms of relocation stress within a short period after admission（P<0.05），and they demonstrated much lower C-GDS-15 total score at 1 week，1 month，2 months after admission（P<0.05），as well as much lower C-SRQ total score，emotional reaction score，somatic reaction score and behavioral reaction score at 2 months after admission（P<0.01）．Conclusion　SBAR communication technique reduces the incidence of relocation stress among elderly people and enhances the work efficiency of nursing homes via improving the reception mode，so it can be widely applied in such institutions.

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16. 北京门诊医师医患沟通技能水平调查

邹晓昭1，周洪丹1，许鼎2，张笑时2，赵铁夫3*

Chinese General Practice 2017, 20 (36): 4543-4546. DOI: 10.3969/j.issn.1007-9572.2017.00.166

Abstract （372）

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目的调查北京市门诊医师医患沟通技能水平。方法 2017年2-4月，采取便利抽样法选取首都医科大学附属北京安贞医院门诊医师99名、病房医师98名,应用医患沟通技能评价（SEGUE）量表进行医患沟通技能水平测评。比较不同性别、类型、科室门诊医师SEGUE量表各维度得分及其总分，比较门诊医师与病房医师、门诊医师与美国门诊医师的SEGUE量表总分的差异。结果 99名门诊医师SEGUE量表总分为4~23分，平均(15.1±4.0)分；女性门诊医师信息收集得分高于男性门诊医师（P＜0.05）；内科门诊医师信息收集得分高于外科门诊医师（P＜0.05）；不同性别、科室门诊医师的SEGUE量表总分比较，差异无统计学意义（P＞0.05）。专家门诊医师准备、信息收集得分及SEGUE量表总分高于普通门诊医师（P＜0.05）；病房医师、美国门诊医师SEGUE量表总分均高于门诊医师（P＜0.05）。结论北京门诊医师医患沟通技能水平明显低于国际水平，与医院重视程度不够有关，故医院管理者应加强医师此方面的意识及教育，提升其医患沟通技能水平，为建立和谐医疗环境奠定基础。

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17. The Role of a Ladderlike Communication Skill Course on Fostering Doctor-Patient Communication Competence of Students in Rural-oriented Free Tuition Medical Education Program

CHEN Enran, SHEN Ying, WEI Yuning, WEI Siyu

Chinese General Practice 2024, 27 (13): 1561-1567. DOI: 10.12114/j.issn.1007-9572.2023.0215

Abstract （371）

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Background

The phase of undergraduate medical education is the starting point for fostering communication competence of students in Rural-oriented Free Tuition Medical Education Program (RTME), which lays the foundation both for communication competence training in the postgraduate education phase and performing effective communications with patients and their relatives, colleagues, and other health personnel in the career life of general practitioners (GPs). It is of great practical significance to explore how to improve quality of doctor-patient communication education in the stage of undergraduate medical education and develop doctor-patient communication competence of the RTME students.

Objective

To explore the role of the ladderlike communication skill course on fostering doctor-patient communication competence of students in rural-oriented free tuition medical education program.

Methods

A total of 259 RTME students of Grade 2019 were selected from Guangxi Medical University in September 2019 to establish Cohort 1, and 262 undergraduate medical students of Grade 2019 were selected to establish Cohort 2. From September 2019 to January 2022, the students in Cohort 1 were trained in a ladderlike communication skill course lasting for five consecutive semesters; from September 2021 to January 2022, the students in both cohorts were trained in a doctor-patient communication course. The final exam scores and process assessment scores of the two cohorts on the doctor-patient communication course were compared and the evaluation of teaching effectiveness and satisfaction of ladderlike communication skill course were investigated in the students in Cohort 1.

Results

The RTME students achieved significantly greater total scores for the final exam of the doctor-patient communication course, in which the RTME students performed better on the sections of case analysis and small essay, but worse on the single-choice question section compared to the undergraduate medical students (P<0.05). Similarly, the RTME students obtained higher scores on the process assessment of the doctor-patient communication course than undergraduate medical students, resulting from higher scores on the dimensions of information collection, information giving, negotiation and resolution, and nonverbal communication skills (P<0.05), and there was no statistically significant difference in the scores on the dimension of establishing first impression (P>0.05). Over 80% of RTME students felt satisfied or absolutely satisfied with the content, pedagogical measures, faculty, schedule and effects of the ladderlike communication skill course, and more than 60% believed it helped or absolutely helped promote learning interest, increase confidence to encounter difficult patients, and raise multiple competence, including empathy, doctor-patient communication, language expression, problem resolution, and team work.

Conclusion

The ladderlike communication skill course significantly elevates the effects of doctor-patient communication education in the phase of undergraduate medical education for the RTME students, facilitates the development of doctor-patient communication competence and other comprehensive competence. The ladderlike course mode is an effective measure fostering doctor-patient communication competence of medical students in medical education, and makes a useful reference for communication competence training for postgraduate education and continuing education of general practice.

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