Application of Case-Based Learning Combined with Teacher-Standardized Patient in Clinical Communication Teaching for Post-Stroke Neurogenic Bladder

doi:10.3969/j.issn.1673-5765.2024.06.013

Abstract

Abstract: Objective To explore the effect of case-based learning (CBL) combined with teacher-standardized patient (TSP) in the teaching of doctor-patient communication for post-stroke neurogenic bladder.
Methods Sixty residents undergoing standardized training at Beijing Tiantan Hospital, Capital Medical University, were included and randomly divided into a control group and an experimental group. The control group received traditional lecture-based learning, while the experimental group received the CBL combined with the TSP approach. The teaching content was a course on doctor-patient communication regarding post-stroke neurogenic bladder, with a total of 12 class hours. After the teaching sessions, residents’ doctor-patient communication skills were assessed using TSP and the set elicit give understand end scale (set the stage, elicit information, give information, understand the patient’s perspective, and end the encounter; SEGUE).
Results There were no significant differences between the control group and the experimental group in terms of age, gender, theoretical exam scores, and operational exam scores at baseline. Following the teaching sessions, residents in the experimental group scored significantly higher than the control group on the SEGUE in the areas of setting the stage [(4.6±0.6) points vs. (3.7±0.8) points, P＜0.0001], eliciting information [(8.6±1.1) points vs. (7.3±0.9) points, P＜0.0001], giving information [(3.7±0.5) points vs. (3.3±0.6) points, P=0.0099], understanding the patient’s perspective [(3.5±0.4) points vs. (2.4±0.7) points, P＜0.0001], and total score [(22.1±1.5) points vs. (18.5±2.0) points, P＜0.0001]. There was no significant difference between the experimental group and the control group in ending the encounter [(1.7±0.6) points vs. (1.7±0.5) points, P=0.6305].
Conclusions The teaching method of CBL combined with TSP can significantly improve the doctor-patient communication skills of residents in dealing with post-stroke neurogenic bladder. This teaching strategy holds promise as an effective means to enhance doctor-patient communication skills in medical education and improve the quality of medical service.

Key words: Case-based learning; Teacher-standardized patient; Doctor-patient communication; Medical education

摘要： 目的探讨案例分析教学法（case-based learning，CBL）联合教师标准化病人（teacher-standardized patient，TSP）在卒中后神经源性膀胱医患沟通教学中的应用效果。
方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师，随机分为对照组和试验组。对照组采用传统以授课为导向的教学法，试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通，共计12学时。教学结束后使用TSP和医患沟通技能评价量表（set the stage，elicit information，give information，understand the patient’s perspective，and end the encounter；SEGUE）评估住院医师的医患沟通能力。
结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后，试验组在SEGUE的问诊准备[（4.6±0.6）分 vs.（3.7±0.8）分，P＜0.0001]、信息采集[（8.6±1.1）分 vs.（7.3±0.9）分，P＜0.0001]、信息提供[（3.7±0.5）分 vs.（3.3±0.6）分，P=0.0099]、患者理解[（3.5±0.4）分 vs.（2.4±0.7）分，P＜0.0001]及总分[（22.1±1.5）分 vs.（18.5±2.0）分，P＜0.0001]方面均显著高于对照组，在问诊结束[（1.7±0.6）分 vs.（1.7±0.5）分，P=0.6305]方面与对照组差异无统计学意义。
结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段，从而提高医疗服务质量。

关键词: 案例分析教学法; 教师标准化病人; 医患沟通; 医学教育

CLC Number:

HAO Qiang, WANG Shouyang, LIU Zhu, ZHANG Yong. Application of Case-Based Learning Combined with Teacher-Standardized Patient in Clinical Communication Teaching for Post-Stroke Neurogenic Bladder[J]. Chinese Journal of Stroke, 2024, 19(6): 725-728.

郝强, 王首洋, 柳竹, 张勇. 案例分析教学法联合教师标准化病人在卒中后神经源性膀胱临床沟通教学中的应用[J]. 中国卒中杂志, 2024, 19(6): 725-728.

References

[1] 中国老年医学学会神经医学分会，天津市卒中学会，王毅，等. 卒中后神经源性膀胱诊治专家共识[J]. 中国卒中杂志，2016，11（12）：1057-1066.
Chinese Geriatrics Society of Neurology，Stroke Association of Tianjin，WANG Y，et al. Expert consensus on diagnosis and treatment of neurogenic bladder after stroke[J]. Chin J Stroke，2016，11（12）：1057-1066.
[2] 罗慧，王强，赵娟，等. 神经源性膀胱的诊治进展[J]. 中华物理医学与康复杂志，2022，44（7）：654-658.
LUO H，WANG Q，ZHAO J，et al. Advances in diagnosis and treatment of neurogenic bladder[J]. Chin J Phys Med Rehabil，2022，44（7）：654-658.
[3] 时志民，李海涛，郭兰凯，等. 临床教学中医学生的医患关系意识的培养[J]. 河北工程大学学报（社会科学版），2020，37（2）：105-109.
SHI Z M，LI H T，GUO L K，et al. Cultivating medical students’ awareness of doctor-patient relationship and its importance in clinical teaching[J]. Journal of Hebei University of Engineering（Social Science Edition），2020，37（2）：105-109.
[4] 刘红，刘姿. 基于GMER的临床本科毕业生人文素质现况分析[J]. 重庆医学，2015，44（25）：3589-3590.
LIU H，LIU Z. Analysis of humanistic quality of clinical undergraduate graduates based on GMER[J]. Chongqing Medicine，2015，44（25）：3589-3590.
[5] 袁青，蒋易涵. 住院医师人文医学核心课程体系的初步研究[J]. 上海交通大学学报（医学版），2013，33（11）：1519-1523.
YUAN Q，JIANG Y H. Preliminary study of humanistic medicine courses system for resident doctors[J]. Journal of Shanghai Jiaotong University（Medical Science），2013，33（11）：1519-1523.
[6] 赵丽，刘艳成，赵胜军，等. 住院医师规范化培训医患沟通能力的考核分析[J]. 医学与哲学，2018，39（4）：68-70，77.
ZHAO L，LIU Y C，ZHAO S J，et al. Analysis on examination of the medical students’ doctor-patient communication ability in the resident standardized training[J]. Medicine & Philosophy，2018，39（7）：68-70，77.
[7] 宋塘悦. 教师标准化病人联合CBL在神经内科护生实习教学中的应用[J]. 中国高等医学教育，2022（7）：129-130.
SONG T Y. Application of teacher-standardized patients combined with CBL in the practice teaching of nursing students in neurology department[J]. China Higher Medical Education，2022（7）：129-130.
[8] 厉岩. 标准化病人在国内外发展历程的回顾与分析[J]. 高校医学教学研究（电子版），2019，9（2）：52-56.
LI Y. Review and analysis of the development history of standardized patients at home and abroad[J]. Medicine Teaching in University（Electronic Edition），2019，9（2）：52-56.
[9] 王岳. 医患关系与医患沟通[M]. 北京：中国协和医科大学出版社，2022.
WANG Y. Doctor-patient relationship and communication[M]. Beijing：Peking Union Medical College Press，2022.
[10] 张鑫，田梅芹，王丽娟，等. 医患沟通认知及培训需求的调查研究[J]. 宁夏医学杂志，2023，45（3）：276-278.
ZHANG X，TIAN M Q，WANG L J，et al. Investigation on cognition and training needs of doctor-patient communication[J]. Ningxia Med J，2023，45（3）：276-278.
[11] CAI W，MUELLER C，LI Y J，et al. Post stroke depression and risk of stroke recurrence and mortality：a systematic review and meta-analysis[J/OL]. Ageing Res Rev，2019，50：102-109[2023-11-20]. https://doi.org/10.1016/j.arr.2019.01.013.
[12] 史艳红. 帕金森病患者睡眠情况及其与负性情绪和生活质量的关系[J]. 国际精神病学杂志，2023，50（4）：796-798.
SHI Y H. Incidence of sleep disturbances in patients with Parkinson’s disease and its relationship to negative emo-tions and quality of life[J]. Journal of International Psychiatry，2023，50（4）：796-798.
[13] 蔡娟丽，付成. 心理支持疗法对慢性前列腺炎负性情绪和生活质量的影响[J]. 中国健康心理学杂志，2022，30（4）：537-541.
CAI J L，FU C. Effect of psychological support therapy on negative emotion and quality of life of chronic prostatitis[J]. China Journal of Health Psychology，2022，30（4）：537-541.