PDF(Pubmed)
Abstract：
BACKGROUND: Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students.
METHODS: The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale.
RESULTS: 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy.
CONCLUSIONS: The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student\'s further course of study.
METHODS: The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale.
RESULTS: 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy.
CONCLUSIONS: The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student\'s further course of study.
摘要：
背景：共情是一项关键能力，对医患关系至关重要。研究证明，医学生在学习期间的同理心持续减少。使用SP对能力获取进行了积极评估，而真正的患者沟通培训对移情授权具有积极影响。因此,本研究集中于模拟患者（SP）与真实患者（RP）沟通训练对本科医学生移情行为的影响。
方法：前瞻性评估是在一个210分钟的医学交流技能实验室单元中进行的，该单元是针对三年级医学生的。研究参与者被提前分配到三组中的一组：一组接受了SP训练（SP组），并被告知这是SP；另一组接受了SP训练，但被认为遇到了RP（隐身患者组（IP组））；最后一组接受了RP训练并被正确告知（真实患者组（RP组）。自我评估的共情是通过使用杰斐逊医师共情量表（JSPE）和人际交往指数（IRI）来衡量的，因为这些是评估同理心最常用的工具。使用咨询和关系移情（CARE）量表对研究参与者的小组相关患者进行移情行为评估。
结果：146名学生参加。JSPE和IRI的自我评估同理心之间没有显着差异。通过CARE进行的外部评估显示，SP组和IP组之间存在统计学上的显着差异，以及SP组和RP组之间。IP组和RP组之间没有显着差异。这意味着与真正的患者（或认为他们是真实的）一起训练的学生在他们的同理心方面的表现评分明显较低。
结论：结果表明，与真实患者一起训练或认为遇到过真实患者的学生的外部同理心评分明显较低；这可能是由于抑制和缺乏常规。因此,我们建议在早期学习期间实施SPs，并在学生的进一步学习过程中逐步整合RPs。
方法：前瞻性评估是在一个210分钟的医学交流技能实验室单元中进行的，该单元是针对三年级医学生的。研究参与者被提前分配到三组中的一组：一组接受了SP训练（SP组），并被告知这是SP；另一组接受了SP训练，但被认为遇到了RP（隐身患者组（IP组））；最后一组接受了RP训练并被正确告知（真实患者组（RP组）。自我评估的共情是通过使用杰斐逊医师共情量表（JSPE）和人际交往指数（IRI）来衡量的，因为这些是评估同理心最常用的工具。使用咨询和关系移情（CARE）量表对研究参与者的小组相关患者进行移情行为评估。
结果：146名学生参加。JSPE和IRI的自我评估同理心之间没有显着差异。通过CARE进行的外部评估显示，SP组和IP组之间存在统计学上的显着差异，以及SP组和RP组之间。IP组和RP组之间没有显着差异。这意味着与真正的患者（或认为他们是真实的）一起训练的学生在他们的同理心方面的表现评分明显较低。
结论：结果表明，与真实患者一起训练或认为遇到过真实患者的学生的外部同理心评分明显较低；这可能是由于抑制和缺乏常规。因此,我们建议在早期学习期间实施SPs，并在学生的进一步学习过程中逐步整合RPs。
