以臨床技能測驗比較六及七年級醫學生的溝通能力

Using An Objective Structured Clinical Examination to Compare the Communication Skills of the 6th- and the 7th-Year Medical Students

背景和目的：臨床溝通技能教學、評估與課程整合為目前醫學教育之新興議題，歐美醫學院校亦積極蒐集相關數據以評估其教學成果。方法：此次我們以客觀結構式臨床考試（OSCE）來評量醫學系六年級與七年級學生溝通技巧表現差異。本文針對輔仁大學醫學系44位六年級醫學生及44位七年級醫學生，在進行 OSCE時同一題的醫病溝通考題之測驗結果進行分析。結果：兩個年級間的醫學生部分表現是有顯著差異的。兩組醫學生在自我介紹與專業形象上的表現相近，在一般禮儀及態度也都能適切表現，七年級醫學生以溫和的態度並使用開放性問題的表現較佳，在「聆聽技巧」及「協商技巧」、「容許」及「建議」皆比六年級醫學生進步。七年級醫學生較會運用傾聽技巧也較能以同理心瞭解病人對問題的感受。在「解釋」方面，「說明高膽固醇血症治療的臨床意義及治療目的」七年級醫學生比六年級醫學生統計上顯著表現稍差。但在「說明服用藥物的好處與風險」則是七年級優於六年級。結論：六年級學生經過一年的醫院歷練後，七年級時的溝通技巧確實有進步的事實，印證溝通技巧是可教導可學習的臨床能力。六、七年級醫學生在醫病溝通技巧方面，雖然都已具備良好的禮儀、態度、及部分技巧，但是在專業知識的專精與口語通俗化的訓練仍有待進一步的加強。

Background and purpose: Recently, the integration of teaching, assessment and curriculum development means that clinical communication skills have begun to play an even more important role in medical education. Medical institutions in the West have begun to actively collect evidence to confirm their teaching outcomes. Evaluation of the relationship between physicians, patients and colleagues should also be emphasized. Methods: Here we used Objective Structured Clinical Examination (OSCE) to evaluate the difference in the communication skills of 6th- and 7thyear medical students. Two groups of 44 sixth-year and 44 seventh-year medical students were assessed for the learning of the clinical communication skills. Results: We discovered that there was a significant difference in the performance of these two groups of subjects. The two groups scored similarly in their self-introductions and the presentation of professional images, and the two groups both performed suitably in general etiquette and attitude. The 7th-year students scored better in gentle attitude and in using open-ended questions, and they showed progress in listening techniques, coordination skills, tolerance, and suggestions over the 6th-year students. The 7th-year students were better at using listening skills, and they were more empathetic. As for explanation part, the 6th-year students explained better in term of the rationale of treatment for hyperlipidemia. In contrast, the benefits and risks of various treatments were delivered more clearly in the 7thyear students. Conclusions: After one year clinical training, students did show progress in their communication skills, proving that communication skills are clinical skills that can be taught and learned. Though the 6th- and 7th-year students all possess good etiquette, attitude, and some techniques, there is still room for improvement in their professional knowledge and their command of using non-technical communication skills.