背景：将患者标记为“非顺应性”是一种非人性化形式，可以剥夺患者在医生心目中的积极人类素质和/或能动性。“不合规”一词在病历文档中经常使用，并已被证明会损害护理，特别是边缘化社区。关于标签对医学学员的影响的文献有限。我们旨在探讨内科住院医师和研究员（受训人员）在与未遵循医生建议的模拟难民患者互动后，如何看待术语“不合规患者”及其对其实践的影响。
方法：Kolb的体验式学习周期指导了教育课程的设计，这是学员所需的沟通技巧课程的一部分。创建了一个场景来模拟一名难民患者，该患者没有遵守他们的治疗计划，并且可能被标记为“不合规”。“学员参加了3小时的会议，其中包括远程模拟的患者相遇，然后是记录和转录的虚拟结构化报告。从使用有关医患关系和去人性化的文献中的临时代码开始，对报告笔录进行了主题分析。
结果：在小组汇报会中，学员反映了标准化的患者病例，并选择讨论他们在临床实践中经历过的类似病例。受训人员指出，“不合规患者”一词具有偏见功能，并描述了这种偏见如何对医患关系产生负面影响。受训者描述了边缘化社区如何更容易受到与“不合规患者”一词相关的负面含义的影响。“对于一些学员来说，该术语引发了对护理潜在障碍的进一步调查，并探索了健康的社会决定因素。
结论：使用短语“不合规的患者，“虽然在医疗实践中很常见，可能会导致学员中病人的非人性化。模拟难民患者的遭遇，然后进行便利的小组汇报，使参与者能够口头表达并反思标签的含义和可能的影响。
BACKGROUND: Labeling a patient \"non-compliant\" is a form of
dehumanization that can deprive the patient of positive human qualities and/or agency in the mind of a physician. The term \"non-compliant\" is frequently used in medical record documentation and has been shown to compromise care, particularly for marginalized communities. There is limited literature on the impact of the label on medical trainees. We aimed to explore how internal medicine residents and fellows (trainees) perceive the term \"non-compliant patient\" and its impact on their practice after interacting with a simulated refugee patient who has not followed a physician\'s recommendations.
METHODS: Kolb\'s experiential learning cycle guided the design of the educational session which was part of a required communication skills curriculum for trainees. A scenario was created to simulate a refugee patient who had not adhered to their treatment plan and could potentially be labeled as \"non-compliant.\" Trainees participated in the 3-h session consisting of a remote simulated patient encounter immediately followed by a virtual structured debrief session that was recorded and transcribed. Thematic analysis of debrief transcripts was conducted starting with the use of provisional codes from the literature on the doctor-patient relationship and de/humanization.
RESULTS: In group debrief sessions, trainees reflected upon the standardized patient
case and chose to also discuss similar cases they had experienced in clinical practice. Trainees indicated that the term \"non-compliant patient\" served as a biasing function and described how this bias negatively impacted the doctor-patient relationship. Trainees described how marginalized communities might be more susceptible to the negative connotation associated with the term \"non-compliant patient.\" For some trainees, the term triggered further investigation of underlying barriers to care and exploration of the social determinants of health.
CONCLUSIONS: The use of the phrase \"non-compliant patient,\" though common in medical practice, may lead to patient
dehumanization among trainees. A simulated refugee patient encounter followed by a facilitated group debrief allowed participants to verbalize and reflect on the meaning and possible impact of the label.
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