目的:确定在客观结构化临床检查(OSCE)期间可能导致尴尬(由礼貌理论(PT)定义为正面威胁面部行为[FTA])或强加感(由PT定义为负面FTA)的潜在敏感情况下影响患者反应的因素,并评估参与者缓解这种情况的能力。
方法:使用PT框架检查了10名药房学员与模拟患者互动的19个OSCE视频记录。所有相关参与者的言语行为都被编码并量化为FTA类型和使用的缓解策略。将患者(评估者)反应分类,然后量化为首选反应(即,快速反应)与不受欢迎的(即,延迟或犹豫的反应)使用对话分析。卡方检验用于根据使用SPSS版本27的预定义假设来识别相关变量之间的任何关联。
结果:共分析了848份FTA。在32.4%的积极FTA中,参与者未能满足患者的面部需求,11.5%的负自由贸易协定中的负自由贸易协定,以及44.4%的正面和负面自由贸易协定。尽管患者披露有关任何不适当的生活方式行为的信息(根据OSCE脚本)通过不受欢迎的举止表达了这些信息,当患者的面部需求以这种方式受到挑战时(68.2%的非首选反应没有得到令人放心的反馈),参与者向患者提供安慰的可能性较小.
结论:建议改进教育计划,以包括患者面部需求的背景和适当处理高度敏感情况的对话策略,以使学员具备有效与患者建立融洽关系的技能。
OBJECTIVE: To identify factors influencing patient responses in potentially sensitive situations that might lead to embarrassment (defined by politeness theory (PT) as positive face-threatening acts [FTAs]) or a sense of imposition (defined by PT as negative FTAs) during Objective Structured Clinical Examinations (OSCEs) and to assess the participant\'s ability to mitigate such situations.
METHODS: Nineteen OSCE video recordings of 10 pharmacy trainees interacting with mock patients were examined using the PT framework. All relevant participants\' speech acts were coded and quantified into type of FTAs and the mitigation strategies used. Patient (assessor) responses were classified then quantified into preferred responses (ie, quick response) vs dispreferred (ie, delayed or hesitant responses) using conversation analysis. The chi-square test was used to identify any association between relevant variables according to predefined hypotheses using SPSS version 27.
RESULTS: A total of 848 FTAs were analyzed. Participants failed to meet patient face needs in 32.4% of positive FTAs, in 11.5% of negative FTAs, and 44.4% of positive and negative FTAs. Although patients disclosing information about any inappropriate lifestyle behavior (as per OSCE scripts) expressed these via dispreferred mannerisms, participants were less likely to provide patients with reassurance when patient face needs were challenged in this way (68.2% of these dispreferred responses were not given reassuring feedback) than when they were maintained.
CONCLUSIONS: Improving educational programs to include the context of patient face needs and conversational strategies for properly dealing with highly sensitive situations was suggested as a way to equip trainees with the skills to effectively build rapport with patients.