以“患者为中心”叙事医学理念在医患沟通课程改革中的渗透与实践

The Penetration and Practice of “Patient-Centered” Narrative Medicine in the Reform of Doctor-Patient Communication Courses

摘要: 当前医患关系是医疗卫生领域重点关注议题，医患沟通作为构建和谐医患关系的核心载体，直接影响医疗服务质量、患者就医体验与临床诊疗工作推进。伴随医学模式由传统生物医学模式向生物–心理–社会医学模式转型，医疗服务不再局限于疾病诊疗，更需兼顾患者个体情感、心理状态、生活经历及社会背景等综合要素。本文以以患者为中心的叙事医学理念为切入点，将其系统渗透于医学生医患沟通课程改革全过程，从研究设计、课程目标、教学内容、教学方法、评价体系多维度构建改革框架，采用准实验前后测结合对照组设计开展教学实践，融合量化统计与质性分析、运用SPSS软件进行数据处理验证改革成效。研究证实，叙事医学理念的融入可显著提升医学生人文素养、共情能力与医患沟通实操能力，同时客观剖析改革现存局限与不足，提出可落地的后续优化路径，为医学人文教育与医患沟通课程提质增效提供实践参考与理论支撑。

Abstract: Doctor-patient relationships are a key issue in the medical and health field. Doctor-patient communication, as the core carrier for building harmonious doctor-patient relationships, directly affects the quality of medical services, patient experience, and the progress of clinical diagnosis and treatment. With the transformation of the medical model from the traditional biomedical model to the biopsychosocial model, medical services are no longer limited to disease diagnosis and treatment, but also need to consider the comprehensive factors such as the patient’s individual emotions, psychological state, life experiences, and social background. This paper takes the patient-centered narrative medicine concept as its starting point and systematically integrates it into the entire process of reforming the doctor-patient communication course for medical students. A reform framework is constructed from multiple dimensions, including research design, course objectives, teaching content, teaching methods, and evaluation system. A quasi-experimental pre- and post-test design combined with a control group is used for teaching practice. Quantitative statistics and qualitative analysis are integrated, and SPSS software is used for data processing to verify the effectiveness of the reform. Research confirms that integrating narrative medicine concepts can significantly improve medical students’ humanistic literacy, empathy, and practical doctor-patient communication skills. It also objectively analyzes the existing limitations and shortcomings of the reform, proposes feasible optimization pathways, and provides practical reference and theoretical support for improving the quality and effectiveness of medical humanities education and doctor-patient communication courses.