以循证医学为导向的问题驱动教学法对住院医师与黑色素瘤患者沟通质量的干预效果

Intervention Effect of Evidence‑Based Medicine‑Oriented Problem‑Based Learning on Communication Quality between Residents and Patients with Melanoma

摘要: 目的：医患沟通不良是导致医疗纠纷与投诉的重要诱因之一。本研究旨在探讨基于循证医学(EBM)的问题驱动教学法(PBL)对住院医师与黑色素瘤患者沟通能力的影响。方法：纳入28名住院医师，随机分为两组，每组14名。PBL组接受基于EBM的问题清单引导式学习，而讲授式学习(LBL)组则接受传统课程教学。培训前由标准化患者(SP)采用沟通质量问卷对住院医师进行基线评分；培训结束后由患者本人评分，出科前再由SP进行评分；同时，高年资医师使用另一份问卷对住院医师的病情汇报沟通能力进行评价。结果：培训后，两组评分均较培训前显著提高。PBL组的总分显著高于LBL组，其中患者评分和SP评分均表现出极显著差异(均p < 0.0001)。此外，PBL组住院医师与高年资医师的沟通效果亦优于LBL组(p = 0.0451)。结论：本研究表明，PBL联合EBM的培训模式可有效提升住院医师与黑色素瘤患者的沟通能力及患者满意度，该教学方法亦有望推广至其他肿瘤患者的沟通培训中。

Abstract: Objective: Poor doctor‑patient communication is one of the important triggers of medical disputes and complaints. This study aimed to explore the effect of evidence‑based medicine (EBM)‑integrated problem‑based learning (PBL) on communication competency of residents when interacting with patients with melanoma. Methods: Twenty‑eight residents were enrolled and randomly assigned into two groups (14 participants per group). The PBL group received guided learning anchored to an EBM‑based question list, whereas the lecture‑based learning (LBL) group underwent conventional didactic lectures. At baseline before training, standardized patients (SPs) assessed residents using a communication quality questionnaire. Upon training completion, real patients completed the same questionnaire, and SPs re‑evaluated residents before rotation completion. Meanwhile, senior physicians adopted a separate questionnaire to evaluate residents’ communication performance in case presentation. Results: Scores in both groups improved significantly after training compared with baseline. The PBL group achieved significantly higher total scores than the LBL group, with highly significant differences identified in both patient‑rated and SP‑rated assessments (both p < 0.0001). Moreover, the PBL group demonstrated superior communication performance with senior physicians relative to the LBL group (p = 0.0451). Conclusion: Our findings suggest that the combined PBL‑EBM training model is associated with improved communication competency of residents caring for patients with melanoma and higher patient satisfaction. This pedagogical approach holds promise for communication training targeting patients with other malignancies.