北部某醫學院醫學生醫病溝通教育介入效果研究─社會認知理論之應用

Abstract

本論文旨在發展一個以社會認知理論設計的醫病溝通教育課程，並探討此課程對參與實習醫學生的醫病溝通能力之影響效果。本研究採準實驗設計，立意取樣某醫學院醫學系五年級學生，實驗組為甲班60位醫學生，施以五週10小時的社會認知理論設計的醫病溝通教育課程；對照組為乙班60位醫學生，施予五週10小時一般講述式的醫病溝通教育課程。兩組受試者皆在課程前、課程後與課程後兩個月透過自擬的「醫病溝通能力問卷」，評量表達能力、傾聽能力、同理反應能力、一般人際互動能力及自我效能等五種能力，該問卷具有良好的信度與專家效度。 本研究有如下發現： 本研究對象醫病溝通能力中的表達、傾聽、同理反應、一般人際互動及自我效能等都屬中上程度，各種能力中以「自我效能」為最佳，「傾聽能力」次之，而「同理反應能力」最差。 本研究根據社會認知理論來設計醫病溝通教育課程，內容除了講述教學外，加入醫病溝通影片欣賞、角色扮演、情境模擬，並結合示範、演練、回饋與小組討論，以促使研究對象在多元刺激下，反覆練習，進而增長醫病溝通能力。 以社會認知理論設計的醫病溝通教育課程介入後，研究對象在「同理反應能力」與「自我效能」方面都具有立即與延宕效果；在「表達能力」方面只有立即效果，而無延宕效果；在「傾聽能力」方面無立即效果，而是經醫院實習兩個月後才顯現出效果；而「一般人際互動能力」方面是既無立即效果，亦無延宕效果。 本研究根據結果提出建議，在醫病溝通教學中利用社會認知理論設計教學，以增加醫學生在表達、傾聽、同理反應、一般人際互動與自我效能之能力，進而改善醫學生醫病溝通之能力。This research aims at the development of physician-patient communication (PPC) training program using the social cognitive theory (SCT) application and the curriculum of training program on the effect of PPC skills for medical students. This study used the quasi-experimental design and recruited 120 five-year medical students in a medical school. In the study group, 60 medical students in class A were given five weeks 10 hours of PCC training program using SCT; while in the control group, 60 medical students in class B were subject to five-week 10 hours of traditional PPC program. Two groups of subjects were assessed by the self-made " self-physician-patient communication skills questionnaire " before, after, and two months after the training program, which included five assessment of expression ability, listening ability, empathy reaction ability, interpersonal interaction ability and self-efficacy of five kinds of abilities. The reliability and validity were high in this questionnaire. This study had the following findings: 1. The expression study of PCC skills, expression ability, listening ability, empathy reaction ability, interpersonal interaction ability and self-efficacy on the genus level, ability to "self-efficacy" perform the best, "listening ability " second, and " empathy reaction ability " the worst. 2. The PPC program was designed based on SCT, which included lectures, film shows, role playing, simulation, demonstration, practice, feedback and panel discussions in order to promote research in multiple stimuli, practice, and growth of PPC abilities in social cognitive theory design. 3. After the intervention with PPC training program designed by SCT, empathy reaction ability and self-efficacy showed both immediate and delay effect; in "expression capacity" aspects showed only immediate effect, no delay effect; in "listening capacity" aspects showed no immediately effect; however, it showed effect after two months of clinical practice at hospital; in "General interpersonal interactive capacity" aspects showed no immediate nor delay effect. Based on the results of this study, SCT designed training program should be provided to improve the expression ability, listening ability, empathy reaction ability, interpersonal interaction ability and self-efficacy of medical students.