Types analysis and coping suggestion of medical disputes arising from medical remarks / 中国医学伦理学

The language expression level of doctors directly affects the effectiveness of information transmission and communication. In the past 20 years， a large number of studies have conducted questionnaire surveys related to “doctor-patient communication” among medical staff and patients in the form of scales， but there were few studies on the practical application of doctor-patient communication and case analysis of doctor-patient disputes. Using the Complaint Register Book of a tertiary A hospital as research material， this paper summarized five causes of medical disputes caused by medical remarks， namely， stiff tone and improper body language of the medical staff， unclear communication of treatment plans， unable to answer patients’ questions， different doctors’ statements are contrary each other， and a large gap between disease prediction and disease development. This paper aimed to analyze the handling points of such disputes， with a view to applying them in doctor-patient communication courses for medical students or language skills training for doctors in the future， optimizing doctor-patient communication， and promoting the development of doctor-patient relationships.

Impact of an Assessment‑Based Training Module on Communication Skills in Phase I Indian Medical Undergraduates

Introduction:Good communication skills (CSs) are not only the crux of a good doctor–patient relationship but also the foundation over which any human relationship is based. The aim of this study was to assess the impact of training on CS in Phase I MBBS students in a Government Medical College in West Bengal, India. MaterialsandMethods: One hundred and eighty‑four Phase I medical students were trained on how to communicate properly with their peers, seniors, teachers, college authorities, department staff, patient relatives, and other health professionals. Each participant underwent a set of three assessments (presession, postsession, and late postsession) for both knowledge and skills in CS. After postsession assessment, feedback by the faculties and peers was provided and reflections were obtained from the participants. A prevalidated questionnaire and Gap‑Kalamazoo CS Assessment Form (with some modification) were used for knowledge and skill’s assessment, respectively. At the end of the module, feedback was collected from the participants. Data were tabulated and results were compared and interpreted. Results: Mean score and standard deviation for knowledge assessment were 5.29 ±1.35, 9 ±1.20 and 8.55 ±0.97 in T1, T2, and T3 and for skills’ score were 17.78 ±4.89, 26.32 ±5.04 and 30.77 ±3.66 in SA1, SA2, and SA3, respectively. Most participants showed improvement in T2 with mean improvement score (T2–T1) of 79.57 ±47.25 and mean retention score (T3–T1) of 71.9 ±47.84. About 52% of participants showed deterioration in T3 with late deterioration score (T3–T2) of−4.06±11.42. 33% showed no change in knowledge, i.e., they retained their improvements, whereas 15% showed further improvement. Fifty‑two percent of participants showed skills’ improvement by scores of 7–12, 43% showed retention by 13–18, and late deterioration was shown by 82%, their scores dropped by 0–6. Conclusion: The training module was successfully implemented, and participants appreciated this type of participant centric assessment‑based teaching learning module. They learned about the effective ways of communication in a fun manner and were determined to apply all that they have learned

Research on the application of Miller's pyramid theory combined with Bahrain's team activities in standardized residency training of burn surgeons / 中华医学教育探索杂志

Objective:To explore the application of Miller's pyramid theory combined with Bahrain's team activities in the standardized residency training (SRT) of burn surgeons.Methods:Seventy-four residents who were on the SRT program in the Department of Burns & Wound Care in The Second Affiliated Hospital of Zhejiang University were enrolled in the study. The students were divided into control group and observation group according to the teaching methods. Thirty-seven students in the control group were provided with conventional teaching, and 37 students in the observation group were provided with training based on Miller' pyramid theory combined with Bahrain's team activities. The two groups were evaluated for teaching effectiveness and doctor-patient communication skills. SPSS22.0 was used for the chi-square test and t test. Results:The evaluation outcome of teaching effectiveness in the observation group was better than that in the control group ( t=3.01, 3.47, 3.49, 3.32, and 2.54; P=0.004, 0.001, 0.001, 0.001, and 0.013). After the training, the scores of Set Elicit Give Understand End scale in the two groups increased, with significantly higher scores achieved in the observation group than in the control group ( t=3.23, 2.99, 2.07, 3.62, 3.00, and 7.89; P=0.002, 0.004, 0.042, 0.001, 0.004, and <0.001). Conclusion:The application of Miller's pyramid theory and Bahrain's team activities in the SRT of burn surgeons can improve students' evaluation of teaching effectiveness and improve their doctor-patient communication skills.

Communication skills and its related factors in Ardabil Alavi Hospital nurses and staff

Background: Communication skills (CS) is an important topic which help the nurses and staff to maintain effective relationships and have professional standards in all legal, ethical and clinical areas. So low level of CS between nurses could be led to more medical mistakes and reduce the patient’s quality of care. The aim of this study was to determine the level of CS among Ardabil teaching hospitals nurses and staff and its related factors.Methods: This descriptive-analytical study was conducted on 145 Ardabil Alavi hospitals’ nurses and staff from May 2019 to November 2019. The data collection tool was communication skills questionnaire of Burton G (1990) which included demographic data and interpersonal communication skills test (18 items) with a range of 18-90. Data analyzed in SPSS version 21 by using descriptive and analytical statistics tests such as; Spearman, Mann-Whitney U, and Kruskal Wallis at significant level of p<0.05.Results: Of all students, 72.4% were women and the rest were men. The average age of participants, was 36.9±8.4 years. The mean score of total communication skills was calculated 59.2±7.3. The mean score of verbal skill, listening skill, and feedback skill were calculated in order to 20.8±3.43, 17.6±4, and 20.7±3.2, respectively. Total Communication skills was significantly related with past work experience but other demographic variables hadn’t significant relation with CS.Conclusions: The results indicated that the CS of Ardabil hospital nurses and staff were in moderate levels. So, providing training programs for raising their CS in future is essential.

Assessment of the Validity and Reliability of a Questionnaire to Evaluate Empathy of Pharmacists / 日本プライマリ・ケア連合学会誌

Introduction: This study assessed the validity and reliability of the Japanese Consultation and Relational Empathy (CARE) Measure in community pharmacist consultations.Methods: We administered an anonymous self-questionnaire about patient consultations with pharmacists to 11 community pharmacies between November 2018 and March 2019.Results: A total of 224 patients completed the questionnaire. Low numbers of missing values and 'not applicable' responses suggested high face validity of the Japanese CARE Measure. Factor analysis resulted in a single solution and internal reliability was high (Cronbach's alpha 0.943). Construct validity was supported by a significant relationship (Spearman's rho 0.43, p<0.01) with the patient's satisfaction with the consultation.Conclusion: The Japanese CARE Measure may be valid and reliable in a community pharmacy setting.

Self Efficacy, Fatigue, Communication Competence and Satisfaction of Clinical Practice and its Related Factors among Some Dental Hygiene Students / 의료커뮤니케이션

PURPOSE: This study was performed to provide basic educational data for improvement of satisfaction in clinical practice by investigating the relationship of clinical practice satisfaction with self-efficacy, fatigue and communication skill in dental hygiene students.METHODS: A survey using a self-administered questionnaire was conducted among 205 second- and third-year students enrolled in an dental hygiene program at three colleges located in A and B province from March 10 to April 10, 2018.RESULTS: Satisfaction level of clinical practice was significantly higher in the group more satisfied with their majors, with more healthy subjective health status, more satisfied with their interpersonal relationships, with a higher self-efficacy, with a lower fatigue, and with better communication skill. Clinical practice satisfaction had a significantly positive correlation with self-efficacy and communication skill and a significantly negative correlation with fatigue. Factors affecting clinical practice satisfaction in the subjects were communication skill, self-efficacy and fatigue. The total variance explained by all three variables was 20%.CONCLUSION: Further studies and development of education programs including a broad range of strategies for clinical training are warranted by reflecting those related variables to improve clinical practice satisfaction in dental hygiene students.

Application of Watson Humanistic Care in Outpatient Nursing / 中国医学伦理学

Selecting outpatient long - term nurses, we conducted the training of Watson humanistic care thoughts and skills to them,created humanistic care facilities,created a humanistic working environment,attached importance to the skills of communicating with patients,paid attention to the details of humanistic care in daily work,strengthened the cultivation of humanistic care consciousness and methods,and constantly improved nurse's ability of humanistic care and service quality of outpatient nursing.

Factors Affecting the Preverbal Communication Skill in Prelingually Deaf Children with Cochlear Implants / 听力学及言语疾病杂志

Objective To study the factors affecting preverbal communication skill in prelingually deaf children with cochlear implants.Methods A total of 31 prelingually deaf children with cochlear implantation participated in the study.They received cochlear implantation the age of 12 months with a mean of 46.71 months.The video analysis were applied to assess the preverbal communication skill including rurn-taking,autonomy,eye contact and auditory awareness.According to the implant age,preoperative use of hearing aids,preoperative speech rehabilitation training,preoperative surgerg ear averrage residual hearing.Wilcoxon signed-rank test was used to evaluate the differences among the groups.The implant age distribution:16 cases in ≤36 months group;15 cases in >36 months group.Preoperative speech rehabilitation training (recovery time more than 3 months) : 14 cases in rehabilitation group, 17 case in no rehabilitation group.Preoperative surgerg ear averrage residual hearing:6 cases in ≤80 dB HL group;25 cases in >80 dB HL group.Preoperative use of hearing aids (use time more than 3 months) distribution: 21 cases in use group, 10 cases in no use group.Results There was statistical signifficance in preoperative use of hearing aids,preoperative speech rehabilitation training,preoperative surgerg ear averrage residual hearing(P0.05).Conclusion Preoperative use of hearing aids,preoperative speech rehabilitation training,preoperative surgerg ear averrage residual hearing in prelingually deaf children with cochlear implants relate with better preverbal communication still.

Discussion of Clinical Nursing and Communication Skills for Perioperative Patients with Liver, Gallbladder, Spleen, and Pancreas Illness in Solution Focused Approach / 中国医学伦理学

Objective:To conduct clinical psychological intervention for the perioperative patients through solu-tion focused approach, excavate potential and improve the adaptation ability. Methods: On the basis of establis-hing a good nurse-patient relationship, the application of the solution focused approach was conducted in the peri-operative patients ( description of the problem, the construction of specific aims, and discussion on the exception, giving feedback, and evaluation of progress) . Results:After the intervention of solution focused approach, the pa-tients′negative emotion such as nervousness, anxiety, fear and depression decreased significantly (P <0. 05). Conclusion:Psychological intervention could effectively eliminate the negative mood of patients, improve the doc-tor-patient relationship, dissolve the contradiction between doctors and patients, reduce the incidence of medical disputes, and thereby enhance mutual understanding, trust and respect between doctors and patients, which makes the doctor-patient relationship more harmonious.

The Effects of Hospital Nurses' Self-Esteem and Communication Skill on Self-Leadership and the Quality of Nursing Service / 간호행정학회지

PURPOSE: The objective of this study was to investigate the influence of hospital nurses' self-leadership, communication skill, and self-esteem on the quality of nursing service. METHODS: The participants, 230 nurses working at a general hospital in Seoul, completed a cross-sectional descriptive questionnaire survey between January 17 and 28, 2014. The collected data were analyzed using the SPSS 19.0 program for descriptive statistics, t-test, one way & two way ANOVA, correlation, and multiple regression analysis. RESULTS: Nurses' self-esteem and communication skill had significant main effects on self-leadership and the quality of nursing service, but the interaction effect of the two independent variables was not significant. Variables that significantly influenced the quality of nursing service were self-leadership, communication skill, self-esteem, and career longevity. The explanatory power of these variables for the quality of nursing service was 54.4%. CONCLUSION: Findings indicate a need for education programs for nurses which are designed to promote communication skill and enhance self-esteem and self-leadership skills which will in turn enhance the quality of nursing service.

Breaking Bad News: An essential skill for doctors

Breaking bad news is a process of delivering news, which may negatively affect a patient’s view of the future, however is an essential skill for doctors. There are a multitude of benefits if doctors can execute this task well, and will improve the disease journey for the patient. There are several published models including the SPIKES and ABCDE models to help guide the doctor to break bad news effectively. This important skill can be taught through various methods but the most effective may be actually observing a session by senior clinicians.

Performance of the curriculum for communication skills for breaking bad news: Evaluation with Common Achievement Tests OSCE and advanced OSCE / 医学教育

Skills for breaking bad news (BBN) at the medical interview station were evaluated with the advanced objective structured clinical examination (OSCE). To clarify performances at this station, we compared the scores at this station with those of the Common Achievement Tests OSCE controlled by the Common Achievements Test Organization (CATO). The subjects were a group of students tested at an interval of 1 year 4 months during their clinical clerkships.1) Raters (mostly postdoctorate fellows) played simulated patients after they had been trained to ensure standardization.2) Students who had high scores for BBN skills on the advanced OSCE also had high scores for both the behavior part and the knowledge part of the total evaluation.3) In contrast, students who had high scores for BBN skills on the advanced OSCE did not always have high scores on the Common Achievement Tests OSCE, suggesting the importance of clinical clerkships between these 2 OSCEs.

The significance of long-term experiential training in welfare facilities for the elderly / 医学教育

1) As part of a training program for compassionate care and community-based medicine, Wakayama Medical University began experiential training for first-year students at local welfare facilities for the elderly in 2006.2) Students were divided into groups of 2 or 3 and sent to welfare facilities for the elderly throughout Wakayama prefecture for 5 days of "on-the-job" training. After the training period, the students completed a questionnaire survey. Survey results from 2006 and 2007 were compared.3) The surveys showed that many students considered the training to be valuable because they could start communicating with the elderly residents of the facility by around the middle of the training period. On the basis of this result, we concluded that the 5 consecutive days of the program enhance the effectiveness of training.

Task-Based Learning: Student’s Perception Of Their Skill In Participating In Small Group Discussions

Task-based learning (TBL) has been accepted as an effective tool in teaching and learning activities in most medical schools. Many studies have looked at competencies and learning outcomes essential for undergraduates. Among the essential competencies are interpersonal skills and the ability to engage in a group discussion which this study has focused on. The evidence supporting higher interpersonal skills is however limited because many relevant competencies are hard to measure and require long observational periods. Objective To determine students’ self-perceived value of TBL in enhancing their interpersonal skills during the clinical phase. Material and Methods All students’ (semesters 6-10) in the clinical school of International Medical University (IMU) were invited to participate in this cross-sectional study done in December 2007 utilising a self-administered questionnaire with a 5-point Likert scale. It assessed the students’ perception on TBL sessions conducted during their clinical attachments in the various disciplines. Mean-scores, standard deviations, and confidence interval were used. Results Response rate was 62%. The results indicated that students were favorable in their opinion on TBL as a suitable forum for active communication and participation in group discussion. The results also show that both male and female students’ have similar perception. As for the comparison according to semesters, this showed that students’ maturity does not influence their perception as well. Conclusion In conclusion, the study has shown positive students’ perception on the effect of TBL on acquired skills such as interpersonal communication. Our findings are consistent with many earlier studies which show students’ perception of the method of learning as important factor in the enhancement of their interpersonal skills which is fundamental to clinical practice. Further research is necessary; long-term and larger scale observational studies would undoubtedly be optimal to minimise response bias.

Canges with school years in the characteristics of nursing students' communication skills in clinical practice-In nursing students on the 3-year couse- / 医学教育

The purpose of this study was to clarify changes with school years in the characteristics of nursing students' communication skill experience in clinical practice. After the completion of clinical practice, nursing students were asked about factors associated with the success and failure of their establishment of communication with patients and communication skills requiring improvement. The described contents were qualitatively analyzed.<BR>1) Concerning factors associated with the success of the establishment of communication, the category most frequently described was “topics” in the first year, “patient's condition” in the second year, and “ways of talking” in the third year. In addition, “non-verbal communication” was frequently observed in the first year.<BR>2) Concerning factors associated with the failure of the establishment of communication, ‘inadequate understanding of patients’ and ‘one-sided questions’ as subcategories of “ways of talking” were commonly observed in the 3 years. As subcategories, “intensity/speed of voice” was extracted in the first year and “i mmature coping with patients' anxiety” in the second and third years.<BR>3) Concerning communication skills requiring improvement, the categories most frequently observed were “ways of talking” and “my own attitude” . As subcategories, ‘ways of initiating the flow of talk ’ and ‘respect for patients’were extracted in the first year, ‘ways of enticing patients to speak’ and ‘overcoming tension’ in the second year, and ‘acceptance’ and ‘self-disclosure’ in the third year.<BR>4) These results suggested the necessity for instructions in the selection of topics and non-verbal communication in the first year, clarification of patients' needs in the second year, and acceptance of patients' feelings in the third year as learning support based on the characteristics of nursing students' communication skill experience in clinical practice in each school year.

Self-efficacy achieved through problem-based learning tutorial / 医学教育

Positive self-esteem helps students build and maintain self-efficacies to affect later clinical practice. We examined the outcome of problem-based-learning (PBL) curriculum by evaluating self-efficacy in terms of sustained learning and clinical competencies among medical school graduates.<BR>1) We compared practicing doctors who either had PBL tutorial experience or who had not by a questionnaire survey.<BR>2) The subjects self-evaluated whether they had achieved expected abilities (1) at the end of undergraduate years, (2) during 2-year internship, and (3) at present.<BR>3) Among 1, 502 doctors surveyed (response rate=36.0%), doctors with PBL tutorial experience had higher selfefficacy (odds ratio>2.1) in their clinical abilities than doctors without it, especially during the school years.<BR>4) In the later 2 periods, doctors with PBL experience had higher self-efficacy in communication skills.<BR>5) PBL tutorial foster self-efficacy in clinical abilities, especially in communication skills, during earlier clinical career.

Evaluation of the Outcome of Communication Skill Training Using a Role Play Model in the Dermatological Clerkship / 대한피부과학회지

BACKGROUND: Communication skill training during medical education, once considered a minor subject, is now ranked as a core clinical skill. OBJECTIVES: The purpose of this study is to evaluate the effectiveness of role play as a method for improving physician-patient communication during the dermatological clerkship. METHODS: Ninety eight senior medical students undergoing dermatological clerkship were included in this study. Initially, the students were briefly lectured on communication skills from a dermatologic professor and two students were randomly allocated for role play. The student in the patient's role was shown the history of the patient with common dermatological problems just before the role play. After the first role play, the patient and physician roles were interchanged and the new student in the patient's role was shown another patient's medical history for the same role play as mentioned above. Two other students were allocated for the third role play with another dermatological problem. A questionnaire survey was used by observing students and the professors to assess the communication skills of the students playing the physician roles in various aspects. After the role plays, the students were allocated to the dermatologic outpatient clinic and with patient consent, they saw real patients as true doctors and the professors evaluated their communication skills using the same questionnaires. RESULTS: As the role plays proceeded, the communication skills of the students were improved. In the outpatient clinic, the students showed better physician-patient communication than ever before. The improvement of communication skills in the outpatient clinic was clearly shown both in the students who had observed the role plays and in those who had performed the physicians' or patients'roles. CONCLUSION: Communication skills in medical students undergoing dermatologic clerkship can be effectively trained, and improved by use of role play.

Patient-Centered Attitudes and Communication Skills in Medical Students after Clerkship / 한국의학교육

PURPOSE: Patient-centered communication is known to improve patient satisfaction, compliance, doctor-patient relationship, and health outcomes. The aim of this study is to evaluate medical students patient-centered communication skills and attitudes in medical students after their clerkship. METHODS: To evaluate medical students' communication skills, OSCE was performed on 114 fourth-year medical students who had completed their clerkship. After OSCE, we used structured questionnaires to survey the subjects in assessing attitudes toward communication skill learning and patient-centeredness. RESULTS: The accomplished frequency of patient-centered communication items were as follows: allow patient's narrative thread (88.6%), open-to-closed-ended questions (47.4%), discuss psychosocial and emotional factors (36.0%), elicit patient's concerns and perspectives (36.0%), discuss how health problem affects patient's daily life (21.9%), express empathy (14.0%), negotiate plan of action with patient (68.4%), and ask whether patient has further issues to discuss (33.3%). The students who did medical service as extracurricular activity and were confident with their communication skills performed better patient-centered interviews. There was no significant relationship between medical students' patient-centered attitudes and patientcentered OSCE scores. CONCLUSION: Having completed their clerkship, medical students were still unable to perform a good patient-centered interview. Current medical curriculum should teach medical students how to communicate in a patient-centered manner. The education method should focus on behavior change initiative.

The Assessment of Undergraduate Curriculum of Communication Skills Evaluated by Performance Measurement Using Actual Outpatient Satisfaction / General Medicine

<B>OBJECTIVE</B>: To evaluate an undergraduate curriculum of communication skills by measuring satisfaction of outpatients whom final year students had examined.<BR><B>METHODS</B>: Cross-sectional surveys were conducted in General Medicine Clinic (GMC) of Saga Medical School (SMS) Hospital in 1999 and 2001. After the clinical clerkship in wards in fifth year, final year students experienced the two-week GMC clerkship, including seven hours of small group lecture in 1999, but partly converted into eight hours of small group discussion with a tutor in 2001. Six items in American Board of Internal Medicine Patient Satisfaction Questionnaire were selected as a validated instrument and incorporated into repeated measures ANOVA.<BR><B>RESULTS</B>: A total of 177 students were evaluated by 688 outpatients. Overall average score was 3.49+/-0.82. Average score in 2001 was significantly higher than that in 1999 (p<0.001; 3.58+ /-0.76vs 3.36+/-0.87) . The scores of“encouraging and answering questions”and“clear explanations”items were significantly lower than those of other items (3.21+/-0.98 and 3.37+/-0.92; Least Significant Difference) . The interaction between gender and years of curricula (1999 and 2001) was significant (p<0.001) ; female students showed remarkable improvement from 1999 to 2001 (Cohen's delta=0.67) .<BR><B>CONCLUSIONS</B>: Patient satisfaction scores indicated that undergraduate curriculum for communication skills in SMS improved from 1999 to 2001. Newly implemented small group discussion was a possible reason for the improvement, especially in female students. Further training for the skills of encouraging and answering questions and clear explanations will be the next step.

Present Status of the SP(Simulated Patient/Standardized Patient) Activity in Japan / 医学教育

The activity of the Simulated patient/Standardized patient has been spreading rapidly in Japan since 1992. At the end of 1998, there are fifteen SP groups all over Japan. Total number of the SP are 108; 21 male and 87 female. We listed all the activity of these SP groups.