Medical students entering the clinic is an indispensable part of medical education and the only way to test whether the theoretical knowledge level of medical students can be combined with practice. When medical students enter the clinic, a thorny problem is how to deal with patients, that is, as medical staff, how to establish a good doctor-patient relationship with patients. The doctor-patient relationship is the most basic, important and core relationship in medical interpersonal relationship, and it is also the basic problem of medical ethics research. Establishing a harmonious doctor-patient relationship is inseparable from effective doctor-patient communication, so it is of great significance to master comprehensive doctor-patient communication skills for establishing a harmonious doctor-patient relationship. The identity of clinical medical students is quite special. They are a special group of medical workers who have just entered the hospital from school. They are both students and medical staff. Many clinical medical students have such confusion after entering the clinic. They can establish good interpersonal relationships with classmates and teachers, but they can't get along well with patients. Therefore, how to communicate effectively with clinical medical students and how to adapt to the role change from "student" to "medical staff" as soon as possible has become an important content in clinical teaching and an important field of medical ethics education in colleges and universities.
1. Investigation on the present situation of doctor-patient communication among clinical medical students
In order to investigate whether clinical medical students can correctly handle the relationship with patients, the author conducted a questionnaire survey on "Communication between medical students and doctors and the handling of doctor-patient conflicts" among 150 clinical medical students and 150 patients in Zhejiang University of Traditional Chinese Medicine. The survey results show that as many as 98.7% of clinical medical students participate in or cause doctor-patient communication conflicts, but what is more worrying is that nearly 92% of clinical medical students say that they don't know how to communicate with patients, how to establish a harmonious doctor-patient relationship with patients, how to deal with and handle existing doctor-patient conflicts in time, and what's more, they are afraid of contacting patients. The lack of communication skills between doctors and patients is manifested in:
(1) The medical information expressed by clinical medical students is unclear and incomplete. Nearly 85% of patients said that they could not understand or were difficult to understand the medical terms described by medical staff. Similarly, nearly 89% of medical students said they didn't know how to describe or explain related medical phenomena in common language.
(2) Clinical medical students seldom use polite expressions when communicating with patients. In the communication with patients, only 12% medical students habitually use polite expressions such as' hello' and' please wait a moment', 27% medical students occasionally use them, and 43% medical students are not used to them.
(3) In the process of patients seeking medical treatment, clinical medical students pay more attention to "asking" than "listening". 93% patients feel that doctors often interrupt their description of their illness when they see a doctor. Similarly, 78% of medical students think that it is more important for doctors to ask about their illness than to listen to it. 82% medical students agree that only the effective description of the patient's condition is heard, and other descriptions (mainly irrelevant to the condition) are ignored.
(4) When listening to patients' complaints, clinical medical students seldom have corresponding emotional reactions. When asked how medical students feel when they see negative psychological activities such as patients' very painful expressions and depressed emotions, only 12% of medical students choose to feel sad and sad like patients, while 46% of medical students choose "this kind of situation often happens in hospitals, and they are used to it, and will not feel sad and sad".
In the overall evaluation of clinical medical students on their doctor-patient communication, 89% people think it is quite difficult to communicate with patients, and 67% patients are dissatisfied with the service of medical staff. It can be seen that there is a great communication obstacle between clinical medical students and patients, and the lack of communication skills between clinical medical students and patients makes this obstacle snowball, which leads to patients' dissatisfaction with medical staff and even the whole hospital, and patients' rejection psychology intensifies the resistance of clinical medical students to doctor-patient communication, thus forming a vicious circle.
2. Analysis of the reasons for the lack of doctor-patient communication ability of clinical medical students.
According to the definition of medical ethics in Medical Staff's Medical Ethics Standards and Implementation Measures issued by the Ministry of Health 1988, the connotation of medical ethics includes seven items: ① saving lives and practicing socialist humanitarianism; ② Respect the personality and rights of patients; ③ Civilized and courteous service; @ Integrity, consciously abide by the law; ⑤ Keep the patient confidential; 6. Learn from each other, respect each other, unite and cooperate; All landowners rigorous and realistic, pioneering and enterprising, studying medicine [2]. The content of medical ethics mostly involves the field of doctor-patient communication, which puts forward qualitative requirements for correct and effective doctor-patient communication. Doctor-patient communication and medical ethics are just like the logical relationship between form and content. Medical ethics is the foundation and core, and communication between doctors and patients is an important embodiment. The medical ethics of medical staff determines their behavior mode of doctor-patient communication; On the contrary, the practice and improvement of doctor-patient communication skills enable them to form communication habits, internalize and improve medical ethics. The two depend on each other and influence each other. One of the "global minimum basic requirements" for undergraduate medical education formulated by the International Medical Education Committee (IIME) is the doctor-patient communication skills [3]. However, the communication ability between doctors and patients is not innate, nor can it be acquired only by theoretical teaching. They must be combined with theory and practice and trained repeatedly in order to be truly and effectively mastered. Therefore, the reason why clinical medical students lack the communication ability between doctors and patients is related to medical students' own family education, personality characteristics and patients' distrust. However, as educators, we have to reflect on the great influence of the lack of medical ethics education in content setting and teaching methods on the cultivation of doctor-patient communication skills.
(1) The course of medical ethics education in colleges and universities has low weight and single content. Take the specialty of traditional Chinese medicine in Zhejiang University of Traditional Chinese Medicine as an example. There are only two courses related to medical ethics and doctor-patient communication, with a total class time of 108 hours, accounting for only 5% of the students' comprehensive training course system. Compared with the 10 course of medical professional foundation and skills, the course of medical ethics education is rare. Due to the lack of medical ethics education courses, medical ethics education not only lost the main battlefield of the first class, but also formed students' subjective understanding of the irrelevant medical ethics education courses. Medical students generally attach importance to the acquisition of medical skills, but despise the cultivation of their own medical ethics, not to mention the cultivation of the communication ability between doctors and patients on campus.
(2) The form of medical ethics education in colleges and universities is mainly classroom teaching, ignoring the practical teaching of medical ethics. Take Zhejiang University of Traditional Chinese Medicine as an example. The two courses related to medical ethics offered by the school are not only taught in the classroom, but also started in the sophomore and junior stages. Students have no contact with clinic at all and have no perceptual knowledge of the relationship between doctors and patients. Therefore, the teaching of these two courses is tantamount to an armchair strategist. In the fourth and fifth years, students go to outpatient clinics, and most of the education is medical skills education, telling students how to operate instruments and how to write medical records. Ignoring medical ethics education in practice. Medical ethics education only stays in books and conceptual cognition, which is undoubtedly a great failure of education. Even in classroom teaching, teachers still focus on the theoretical presentation of textbooks, and rarely use flexible teaching methods such as case teaching and role-playing teaching. The result of this indoctrination teaching is that even though students know the importance of doctor-patient communication, they don't know how to communicate well with doctors and patients, which makes medical ethics education fall into an embarrassing situation of "teaching people to fish" instead of "teaching people to fish", and also deviates from the original intention of medical ethics education to "train qualified medical personnel".
(3) The object of medical ethics education is only for students, and there is no medical ethics re-education for teachers. The object of medical ethics education should be all medical staff, and the process of moral acquisition should run through every medical staff's life. It should have been the best time for medical ethics education to take up clinical posts, but now it has become the end time of education. Moreover, the best teaching method of medical ethics education is to teach by example, but in reality, some teachers have low humanistic quality, and some uncivilized, uncivilized and even morally corrupt behaviors are openly exposed to students, which has a great influence on the formation of students' values, right and wrong, and moral values. The survey shows that more than 90% students choose teachers' behavior as the most important factor affecting students' professional ethics. Therefore, the lack of teachers' medical ethics education and the neglect of the importance of doctor-patient communication are important factors that lead to the weak medical students' medical ethics awareness and neglect of doctor-patient communication.
3. Improve the medical ethics education system, and promote the improvement of clinical medical students' communication ability between doctors and patients.
The improvement of doctor-patient communication skills is of great significance for establishing a harmonious doctor-patient relationship between medical students and patients. At the same time, the communication ability of medical students is also an important indicator to reflect their own humanistic cultivation, medical style and medical outlook. The author believes that the following educational countermeasures can be tried to improve the communication ability of medical students:
(1) Accelerate the reform process of medical ethics education and establish a relatively complete medical ethics education and teaching system. First, expand medical ethics education related courses. Educators and administrators of medical colleges should fully realize that medical students' medical ethics education is an indispensable part of medical education, and teaching administrators should focus on developing more courses related to medical ethics education and increase the weight of medical ethics education courses; Secondly, combine medical ethics education with college students' mental health education and ideological and political education. Ethics and psychology, Marxist theory and other disciplines are inherently interdisciplinary. Combining medical ethics education with mental health education and ideological and political education can not only expand the platform of medical students' medical ethics education, make up for the weakness of medical ethics education in the first class, but also promote medical students' mental health, cultivate their good political and moral cultivation, and urge medical students to understand medical ethics concepts such as "doctors are kind, heal the wounded and rescue the dying" and "patient-centered" from a new perspective.
(2) Accelerate the transformation of teaching methods of medical ethics education. In particular, the teaching method of doctor-patient communication skills should not only stay in theoretical study, but also carry out classic case teaching of doctor-patient relationship, role-playing teaching of doctor-patient relationship sitcom and practical teaching of clinical doctor-patient relationship handling, so as to combine classroom teaching with extracurricular activities, and combine theoretical study with practical experience, so that medical students can master communication skills such as listening, explaining, repeating, emphasizing and feeling. Medical colleges and universities can take the training course of doctor-patient communication skills as a compulsory course for medical students to go to the clinic, and quantitatively assess the doctor-patient communication skills of medical students who are about to enter the clinic, so as to encourage students to actively learn and practice the doctor-patient communication skills, make the skills become behavioral habits, and sublimate their own medical ethics.
(3) Strengthen the training of doctor-patient communication skills and re-education of medical ethics. Students are excellent imitators, imitation and practice are their main learning methods, and teachers' words and deeds have a great influence on medical students. Therefore, hospitals should pay attention to regular medical ethics training for teachers, so that teachers can establish the consciousness of "setting an example for students", standardize their words and deeds and improve their medical ethics. At the same time, clinical teaching teachers should pay attention to the cultivation of their students' medical ethics, and guide clinical medical students to always establish the idea of "patient-centered". When patients are critical of clinical medical students, clinical teaching teachers should patiently explain to patients with practical actions to help them get the understanding of patients and set a good example for clinical medical students to communicate with doctors and patients.
(4) Increase the time for medical students to get along with patients and create more communication opportunities. Contacting real patients in clinical practice is not only a test of clinical medical students' learning achievements in doctor-patient communication ability, but also the best way to improve doctor-patient communication ability quickly. The above questionnaire survey also shows that nearly 78.4% of the conflicts between doctors and patients caused by clinical medical students occurred in the first half of the internship. Therefore, clinical teaching teachers should encourage clinical medical students to be as close as possible to patients and communicate with them more. Don't be discouraged even if you encounter rejection or coldness. The practice management department can also formulate corresponding systems, such as establishing a daily consultation system for clinical medical students to ensure the opportunity of direct communication between clinical medical students and patients.
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