의과대학 학생의 실제 환자 진료와 표준화 환자 진료 간의 환자 중심 면담 특성 비교

Abstract

Purpose: Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient–centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX). Methods: During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students’ CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC). Results: The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7),and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other. Conclusion: Medical educators must emphasize the importance of exploring a patient’s illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.