困難醫病溝通下醫療人員需具備的技巧：實習醫學生與專家的觀點比較

Skills Required for Healthcare Professionals to Tackle Challenging Doctor-Patient Communication: A Comparison of Perspectives between Medical Clerks and Experts

目的：面對困難病人乃至於困難醫病溝通不論是對於醫學生或是執業多年的醫師都是個挑戰，理解醫學生和專家對於應對困難醫病溝通認為所需技能的看法可以幫助教育者訂定教學策略。

方法：本研究分二部分：學生面是針對九十九份五年級醫學生的書面報告，以質性研究的主題分析法分析書寫內容，在編碼後進行文意歸類與出現次數計算。專家面則是由八位專家組成共識會議，以名義團體法進行討論，以投票數的高低決定所需技能的重要度分數。

結果：醫學生認為同理心、溝通技巧、了解病人需求、專業知識和堅守底線是面對困難醫病溝通時最需要的技能。而專家則強調傾聽技巧、同理心、邏輯思辨、開放態度和自我覺察的重要性，並且認為法律素養、跨團隊資源的運用、關心他人、多元文化觀念等素養也相當重要。

結論：醫學生和專家都同意同理心是重要的技能，學生更重視專業知識的精進，相對地，專家更注重跨領域合作和自我覺察，這反映在醫病溝通中，不同階段的醫療人員可能會因為經驗和角色的不同而有不同的焦點和需求，在課程設計上應綜合考量，將兩者注重的面向融入教學。

 

Background/Purpose: Managing or interacting with difficult patients poses a steep challenge for medical students and experienced clinical physicians alike. Understanding the perspectives of medical students and experts on the skills needed to handle challenging medical-patient communications can aid educators in developing effective teaching strategies.

Methods: The study was conducted in two phases. 99 reports written by fifth-year medical students were first gathered and examined using the thematic analysis method of qualitative research. After coding, main themes (i.e. required skills) were categorized and the frequencies of their occurrences quantified. Eight experts were invited to hold a consensus meeting, employing the nominal group technique to discuss and vote on the importance of various skills required for managing difficult doctor-patient communications.

Results: Medical students identified empathy, communication skills, understanding of patient needs, professional knowledge, and maintenance of ethical standards as crucial when coping with difficult doctor-patient communications. Experts emphasized the importance of listening, empathy, logical thinking, openness, and self-awareness. They also highlighted the significance of legal literacy, ability of utilizing cross-team resources, compassion, and appreciation for cultural diversity as vital.

Conclusion: Both medical students and experts agree on the importance of empathy. Students focus more on enhancing their professional knowledge, while experts place greater importance on cross-disciplinary cooperation and self-awareness. The needs and focus areas of medical professionals vary with their experiences with and roles in doctor-patient communication. Both the differences and common emphases should be considered in curriculum design for integration into teaching.