慢性病诊疗带教中的“隐性课程”对医德养成有心理连带效果吗？—一项基于多教学医院数据的实证分析

Did “Hidden Curriculum” in Clinical Teaching of Chronic Disease Have a Psychological Joint Effect on the Development of Medical Ethics?—An Empirical Analysis Based on Data from Multi-Central Teaching Hospitals

摘要: 探讨医德学习中“隐性课程”的作用，采用非参与观察与问卷调查对临床实习医学生进行研究，发现表现为临床经验内化且体现师生互动关系的“隐性课程”中，以及在“隐性课程”强调尊重、沟通、信任、关怀的师生互动模式中，学习氛围营造，典范学习，同伴及临床体验，医院制度环境等维度会对医学生医德学习的心理连带产生正向效果。具体而言，让医学生印象深刻的临床事件，往往也伴有助力其医德认知的连带效果。“医院制度环境”构面对医学生人文关怀、伦理、诚信正直，以及责任心水平有重要的影响。“学习氛围营造”、“典范学习”、以及“同伴及临床事件影响”可以对“以病人为中心的沟通”的表现情况产生一定解释力。

Abstract: This paper discusses the role of “hidden curriculum” in medical ethics learning, and uses non-participation observation, interview and questionnaire to search the medical students who participate in clinical practice. It is found that in the “hidden curriculum” which shows the inter-nalization of clinical experience and embodies the interaction between teachers and students and its teacher-student interaction model which emphasizes respect, communication, trust and care, building learning atmosphere, model learning, peer and clinical experience, and the hospital system environment will have positive effects on the psychological connection of medical students’ medical ethics. Specifically, clinical events that impressed are often accompanied with the joint effect of development of medical ethics. The dimensions of “hospital institutional environment” have an important impact on medical students’ humanistic care, ethics, integrity, and the level of responsibility. The “learning atmosphere building”, “model learning”, and “the impact from peer and clinical events” have explanatory power about performance of “patient-centered communication”.