诊断学床旁教学中学患关系调查分析及对策

目的　探讨诊断学床旁见习教学中学患关系现状，为提高诊断学床旁教学质量提供应对策略。方法　采用自行设计问卷，于2010年5月-2011年6月对80名临床医学专业三年级本科生以及同期在内科住院的100例患者分别进行不署名学患关系问卷调查（有效问卷率分别为91.3%和67%），同时对8名带教教师和7名临床主管医生进行个别访谈。结果　学生问卷调查显示，79.5%的学生曾在床旁教学中遭遇患者不同程度的拒绝或不配合，大多数学生认为有被拒的心理准备和承受力。患者调查显示，82.1%的患者不愿意接受学生问诊查体，58.2%的患者表示即便给予一定经济补偿，也不愿配合教学。而对带教教师及临床主管医师访谈结果显示，当前床旁带教难度大大增加，学患关系紧张。结论　现阶段学患关系紧张，根据其涉及原因，提出提升医务人员及医学生人文观念，推进医疗、教育体制改革，建立媒体监督机制，开展公众教育等多层面的应对策略，同时提出课程设置、教学模式、师资培养等具体教学应对举措。Objective　Toexplorethepresentstatusoftherelationshipbetweenstudentsandpatientsindiagnosticbedsideteaching,inordertopromotetheteachingquality.Methods　FromMay2010toJune2011,self-madequestionnaireswereadoptedtocarryoutananonymoussurveyamong80medicalstudentsingradethreeoraboveand100inpatientstoinvestigatetherelationshipbetweenthestudentsandthepatients(withaneffectivequestionnairerateof91.3%and67%respectively).Eighttutorsand7physiciansconcernedweretakenintheindividualinterview.Results　Thesurveyshowedthat79.5%ofthestudentsencounteredrefusalfrompatientsinbedsideteaching,andmostofthembelievedthattheyhadpsychologicalpreparationandendurancefortherefusal.Atotalof82.1%ofthepatientsexpressedtheirunwillingnesstoacceptexaminationbyclinicalstudents,and58.2%ofthepatientswereunwillingtocooperateintheteachingevenwithanamountofeconomiccompensation.Thetutorsandphysiciansconcernedstatedthatthestudent-patientrelationshipwasundesirableatpresent.Conclusions　Therelationshipbetweenstudentsandpatientsinbedsideteachingisstrainedatpresent.Basedonthecomplicatedreasons,weproposesuchcopingstrategiesaspromotinghumanismamongmedicalworkersandstudents,pushingforwardthemedicalandeducationalreform,buildingmediasupervision,developingpubliceducation,perfectingcoursedesign,teachingstyle,andcultivationofteachers,andsoon.