Temel Hekimlik Uygulamaları Dersleri İçerisinde Edinilen İletişim ve Öykü Alma Becerilerinin Klinik Stajlarda Kullanıp Kullanılmadığının Değerlendirilmesi

Öz

AMAÇ: Literatürde, yüksek iletişim becerilerine sahip olan hekimlerin; hasta memnuniyetini artırma, tedaviye uyumu sağlama ve hasta sonuçlarını iyileştirmede daha başarılı oldukları ve daha az tükenmişliğe ve şiddete maruz kaldıkları belirtilmektedir. Bu çalışmanın amacı, Dönem III te verilen iletişim ve öykü alma becerisi eğitimlerini, Dönem IV stajlarında gerçek klinik ortamda ne kadar kullanabildiklerini değerlendirmektir. YÖNTEM: Bu çalışma kesitsel bir gözlem çalışması olup, çalışmaya 2022-2023 akademik yılında dönem III temel hekimlik uygulamalarını almış olan tüm öğrenciler dahil edilmiştir. 2022-2023 akademik yılında bu programı alan öğrencilere, dönem IV te 2023-2024 yılının mart ayında araştırmacıların konsensusu ile oluşturulan ve bir sene önce eğitimde kazanılan iletişim ve öykü alma becerilerini gerçek klinik ortamda ve staj eğitimlerinde kullanılıp kullanılamadığına dair 5’li likert ve açık uçlu sorulardan oluşan bir anket uygulanmıştır. Analiz için tanımlayıcı istatistikler ve açık uçlu metinler için klasik metin analizi yapılmıştır. BULGULAR: Öğrencilerin, eğitim aldıkları yılda verdikleri geri bildirimlerde, eğitimden yüksek oranda memnun kaldıkları ve iletişim bileşeninin becerilerini olumlu yönde etkilediğini belirtmişlerdir. Dönem IV’te aynı öğrencilerin büyük çoğunluğunun dönem III’ te eğitimini aldıkları iletişim ve hasta öyküsü alma becerilerini kullandıklarını, klinik ortamda özgüvenlerini ve staj başarısını olumlu yönde etkilediğini, klinik ortama adaptasyonlarını kolaylaştırdığını, edindikleri becerilerin kalıcı olduğunu ve profesyonel kimliklerine olumlu yönde katkısı olduğunu belirtmişlerdir. Açık uçlu sorulara verilen cevapların analizinde ortaya çıkan belirgin temalar, aldıkları eğitimi gerçek klinik ortamda kullanmakta zorluk yaşamadıkları, hastalarla yeterli iletişim kurabildikleri ve bütüncül yaklaşabildikleri, hocalarla iletişimi kolaylaştırmış olması, öz güven artışıdır. SONUÇ: Dönem IV öğrencileri Dönem III eğitimleri sırasında temel hekimlik uygulamaları koridoru çerçevesinde aldıkları iletişim ve öykü alma becerilerini, gerçek klinik ortamda zorluk yaşamadan kullanabilmişler ve kalıcı hale getirmişlerdir. Aldıkları eğitim hocalarla iletişimlerini, staj başarılarını, profesyonel kimliklerini ve öz güvenlerini de olumlu yönde etkilemiştir.

Anahtar Kelimeler

• Tıp eğitiminde iletişim becerileri eğitimi
• Temel hekimlik uygulamaları
• İletişim eğitiminin performans üzerindeki etkisi

Evaluation of the Use of Communication and History Taking Skills Acquired in Basic Medical Practice Courses in Clinical Internships

Öz

AIM: In the literature, it is stated that physicians with high communication skills are more successful in increasing patient satisfaction, ensuring compliance with treatment and improving patient outcomes, and are less exposed to burnout and violence. The aim of this study was to evaluate the extent to which the students were able to use the communication and history taking skills trainings given in Term III in the real clinical environment in Term IV internships. METHOD: This study is a cross-sectional observational study, and all students who took the basic medicine practices in the academic year 2022-2023 were included in the study.. In the 2022-2023 academic year, a questionnaire consisting of 5-point Likert and open-ended questions about whether the communication and history-taking skills gained in the education one year ago could be used in the real clinical environment and internship training was applied to the students who received this programme in the 2022-2023 academic year. Descriptive statistics and classical text analysis for open-ended texts were used for the analysis. RESULTS: In the feedback given by the students in the year they received training, they stated that they were highly satisfied with the training and that the communication component positively affected their skills. In Term IV, the majority of the same students stated that they used the communication and patient history taking skills they had received training in Term III, that it positively affected their self-confidence and internship success in the clinical environment, facilitated their adaptation to the clinical environment, that the skills they acquired were permanent and contributed positively to their professional identity. The prominent themes that emerged in the analysis of the answers given to the open-ended questions were that they had no difficulty in using the training they received in the real clinical environment, they could communicate adequately with patients and approach holistically, it facilitated communication with the instructors, and increased self-confidence. CONCLUSION: Term IV students were able to use the communication and history-taking skills they learnt in the corridor of basic medical practice during their Term III education in the real clinical environment without any difficulty and made them permanent. The training they received also positively affected their communication with their teachers, their internship success, their professional identity and self-confidence.

Anahtar Kelimeler

• Communication skills training in medical education
• Basic medical practices
• The effect of communication training on performance

Kaynakça

1. Kaynakça 1. Golda N, Beeson S, Kohli N, Merrill B. Recommendations for improving the patient experience in specialty encounters. Journal of the American Academy of Dermatology [İnternet]. 01 Nisan 2018 [a.yer 27 Ağustos 2024];78(4):653-9. Erişim adresi: https://www.sciencedirect.com/science/article/pii/S0190962217317899
2. 2. Burgener AM. Enhancing Communication to Improve Patient Safety and to Increase Patient Satisfaction. Health Care Manag (Frederick). 2017;36(3):238-43.
3. 3. Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review. Int J Qual Health Care. 01 Ekim 2017;29(6):752-68.
4. 4. Tavakoly Sany SB, Behzhad F, Ferns G, Peyman N. Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC Health Serv Res [Internet]. 23 Ocak 2020 [a.yer 27 Ağustos 2024];20(1):60. Erişim adresi: https://doi.org/10.1186/s12913-020-4901-8
5. 5. de Frutos Ricart C. Habilidades sociales y comunicativas en los profesionales de la salud y sus efectos. 15 Nisan 2024 [a.yer 28 Ağustos 2024]; Erişim adresi: http://dspace.uib.es/xmlui/handle/11201/165360
6. 6. Celikkalp U, Bilgic S, Temel M, Varol G. The Smartphone Addiction Levels and the Association With Communication Skills in Nursing and Medical School Students. Journal of Nursing Research [İnternet]. Haziran 2020 [a.yer 27 Ağustos 2024];28(3):e93. Erişim adresi: https://journals.lww.com/jnr-twna/fulltext/2020/06000/The_Smartphone_Addiction_Levels_and_the.10.aspx
7. 7. Howick J, Moscrop A, Mebius A, Fanshawe TR, Lewith G, Bishop FL, vd. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med [Internet]. 01 Temmuz 2018 [a.yer 27 Ağustos 2024];111(7):240-52. Erişim adresi: https://doi.org/10.1177/0141076818769477
8. 8. Patel MR, Song PXK, Bruzzese JM, Hao W, Evans D, Thomas LJ, vd. Does cross-cultural communication training for physicians improve pediatric asthma outcomes? A randomized trial. Journal of Asthma [İnternet]. 04 Mart 2019 [a.yer 28 Ağustos 2024];56(3):273-84. Erişim adresi: https://doi.org/10.1080/02770903.2018.1455856

9. 9. Aryankhesal A, Mohammadibakhsh R, Hamidi Y, Alidoost S, Behzadifar M, Sohrabi R, vd. Interventions on reducing burnout in physicians and nurses: A systematic review. Med J Islam Repub Iran. 2019;33:77.
10. 10. Messerotti A, Banchelli F, Ferrari S, Barbieri E, Bettelli F, Bandieri E, vd. Investigating the association between physicians self-efficacy regarding communication skills and risk of “burnout”. Health Qual Life Outcomes. 06 Ağustos 2020;18(1):271.
11. 11. Du J, Mayer G, Posenato E, Hummel S, Zafar A, Bärnighausen T, vd. Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey. BMC Med Educ [Internet]. 12 Kasım 2022 [a.yer 28 Ağustos 2024];22(1):783. Erişim adresi: https://doi.org/10.1186/s12909-022-03830-9
12. 12. Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, vd. A Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology [İnternet]. 01 Kasım 2021 [a.yer 27 Ağustos 2024];161(5):1670-1688.e7. Erişim adresi: https://www.sciencedirect.com/science/article/pii/S0016508521033205
13. 13. Mata ÁN de S, de Azevedo KPM, Braga LP, de Medeiros GCBS, de Oliveira Segundo VH, Bezerra INM, vd. Training in communication skills for self-efficacy of health professionals: a systematic review. Hum Resour Health [Internet]. 06 Mart 2021 [a.yer 27 Ağustos 2024];19(1):30. Erişim adresi: https://doi.org/10.1186/s12960-021-00574-3
14. 14. Aşcı Ö, Hazar G, Yılmaz M. Sağlık Yüksekokulu Öğrencilerinin İletişim Becerileri ve İlişkili Değişkenler. Acibadem Univ Saglik Bilim Derg [İnternet]. 01 Eylül 2015 [a.yer 27 Ağustos 2024];(3):160-5. Erişim adresi: http://journal.acibadem.edu.tr/en/pub/acusaglik/issue/61309/914406
15. 15. Sögüt S, Cangöl E, Dinç A. Hemşirelik Öğrencilerinin İletişim Beceri Düzeylerinin Belirlenmesi. Researcher [İnternet]. 01 Ocak 2018 [a.yer 27 Ağustos 2024];6(2):272-80. Erişim adresi: https://dergipark.org.tr/en/pub/researcher/issue/66630/1042653
16. 16. Kazu E, Düşükcan M. HEMŞİRELİK ÖĞRENCİLERİNİN SOSYAL ZEKÂ DÜZEYLERİNİN İLETİŞİM BECERİLERİNE ETKİSİ. Fırat Üniversitesi Sosyal Bilimler Dergisi [İnternet]. 20 Ocak 2021 [a.yer 27 Ağustos 2024];31(1):215-30. Erişim adresi: https://dergipark.org.tr/en/pub/firatsbed/issue/59903/804237
17. 17. Yılmaz D, Akay B. Hemşirelik Öğrencilerinin Çocuk Sevme Durumları ile İletişim Becerileri Arasındaki İlişki. SBÜHD [İnternet]. 12 Ağustos 2022 [a.yer 27 Ağustos 2024];4(2):53-60. Erişim adresi: https://dergipark.org.tr/en/pub/sbuhemsirelik/issue/71639/1021078
18. 18. Elkin N, Karadağlı F, Barut Y. Sağlık bilimleri yüksekokulu öğrencilerinin iletişim becerileri düzeyleri ve ilişkili değişkenlerin belirlenmesi. Mersin Univ Saglık Bilim derg [Internet]. 10 Ağustos 2016 [a.yer 27 Ağustos 2024];9(2):70-80. Erişim adresi: https://dergipark.org.tr/en/pub/mersinsbd/issue/24537/259939
19. 19. Kaya N, Turan N, Kamberova HA, Cenal Y, Kahraman A, Evren M. Communication skills and social intelligence level of nursing students according to art characteristics/Hemsirelik ogrencilerinin sanat ozelliklerine gore iletisim becerileri ve sosyal zeka duzeyleri. Journal of Education and Research in Nursing [Internet]. 01 Ocak 2016 [a.yer 27 Ağustos 2024];13(1):282-91. Erişim adresi: https://go.gale.com/ps/i.do?p=HRCA&sw=w&issn=13050397&v=2.1&it=r&id=GALE%7CA469210494&sid=googleScholar&linkaccess=abs
20. 20. Karakaş SA, Polat H. Bir Psikiyatri Hastanesinde Çalışan Hemşirelerin Profesyonel Benlik Kavramı ve İletişim Beceri Düzeylerinin İncelenmesi. KTOKUSB-D [İnternet]. 27 Nisan 2022 [a.yer 27 Ağustos 2024];3(1):58-70. Erişim adresi: https://dergipark.org.tr/en/pub/ktokusbd/issue/69608/1054083
21. 21. Eskandari M, Hosseini F, Razjouyan K, Abadi A. Examining doctor-patient communication skills among senior medical students based on calgary cambridge observation guide. Med J Islam Repub Iran. 2021;35:122.
22. 22. Çeken N, Kuyucak E. Sağlık Hizmetleri Meslek Yüksekokulunda Eğitim Alan Öğrencilerin İletişim Beceri Düzeyleri. EurasianJHS [İnternet]. 30 Ocak 2020 [a.yer 27 Ağustos 2024];3(1):6-10. Erişim adresi: https://dergipark.org.tr/en/pub/avrasyasbd/issue/52172/561820
23. 23. Rafique E. The necessity for the education of medical students’ communication skills in the preclinical years of their MBBS program. Journal of the Pakistan Medical Association [Internet]. 15 Şubat 2023 [a.yer 28 Ağustos 2024];73(2):442-3. Erişim adresi: https://ojs.jpma.org.pk/
24. 24. Bosméan L, Chaffanjon P, Bellier A. Impact of physician–patient relationship training on medical students’ interpersonal skills during simulated medical consultations: a cross-sectional study. BMC Med Educ [Internet]. 22 Şubat 2022 [a.yer 28 Ağustos 2024];22(1):117. Erişim adresi: https://doi.org/10.1186/s12909-022-03171-7
25. 25. Harnischfeger N, Rath HM, Alt-Epping B, Brand H, Haller K, Letsch A, vd. Effects of a communication training for oncologists on early addressing palliative and end-of-life care in advanced cancer care (PALLI-COM): a randomized, controlled trial. ESMO Open [İnternet]. 01 Aralık 2022 [a.yer 28 Ağustos 2024];7(6):100623. Erişim adresi: https://www.sciencedirect.com/science/article/pii/S2059702922002575
26. 26. Kienle R, Freytag J, Lück S, Eberz P, Langenbeck S, Sehy V, vd. Communication skills training in undergraduate medical education at Charité – Universitätsmedizin Berlin. GMS J Med Educ [İnternet]. 15 Mart 2021 [a.yer 28 Ağustos 2024];38(3):Doc56. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994867/
27. 27. Jiang Y, Shi L, Cao J, Zhu L, Sha Y, Li T, vd. Effectiveness of clinical scenario dramas to teach doctor-patient relationship and communication skills. BMC Med Educ. 26 Kasım 2020;20(1):473.
28. 28. Mulcare M, Naik N, Greenwald P, Schullstrom K, Gogia K, Clark S, vd. Advanced Communication and Examination Skills in Telemedicine: A Structured Simulation-Based Course for Medical Students. MedEdPORTAL. 17 Aralık 2020;16:11047.
29. 29. Amsalem D, Gothelf D, Soul O, Dorman A, Ziv A, Gross R. Single-Day Simulation-Based Training Improves Communication and Psychiatric Skills of Medical Students. Front Psychiatry. 2020;11:221.
30. 30. Przymuszała P, Marciniak-Stępak P, Cerbin-Koczorowska M, Borowczyk M, Cieślak K, Szlanga L, vd. ’Difficult Conversations with Patients’-A Modified Group Objective Structured Clinical Experience for Medical Students. Int J Environ Res Public Health. 27 Mayıs 2021;18(11):5772.
31. 31. Zemlin C, Nourkami-Tutdibi N, Schwarz P, Wagenpfeil G, Goedicke-Fritz S. Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students. BMC Med Educ. 12 Şubat 2024;24(1):134.
32. 32. Eklics K, Csongor A, Hambuch A, Fekete JD. Diverse Integration of Simulated Patients in Medical Education for Communication, Language, and Clinical Skills in Hungary. Adv Med Educ Pract. 2024;15:301-12.
33. 33. Zerbini G, Reicherts P, Reicherts M, Roob N, Schneider P, Dankert A, vd. Communication skills of medical students: Evaluation of a new communication curriculum at the University of Augsburg. GMS J Med Educ. 2024;41(3):Doc26.
34. 34. Barbosa M, Del Piccolo L, Barbosa A. Effectiveness of a brief training program in relational/communication skills for medical residents. Patient Education and Counseling [İnternet]. 01 Haziran 2019 [a.yer 28 Ağustos 2024];102(6):1104-10. Erişim adresi: https://www.sciencedirect.com/science/article/pii/S073839911930031X
35. 35. Johnson J, Panagioti M. Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis. Academic Medicine [İnternet]. Eylül 2018 [a.yer 28 Ağustos 2024];93(9):1400. Erişim adresi: https://journals.lww.com/academicmedicine/abstract/2018/09000/interventions_to_improve_the_breaking_of_bad_or.36.aspx
36. 36. Geoffroy PA, Delyon J, Strullu M, Dinh AT, Duboc H, Zafrani L, vd. Standardized Patients or Conventional Lecture for Teaching Communication Skills to Undergraduate Medical Students: A Randomized Controlled Study. Psychiatry Investig [İnternet]. Nisan 2020 [a.yer 28 Ağustos 2024];17(4):299-305. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176569/
37. 37. Ruck J, Pramberger M, Späth I, Simmenroth A, Zirkel J. “And how am I going to ask about this?” - introducing the course “sexual anamnesis” in peer teaching for medical students in Würzburg. GMS J Med Educ. 2023;40(1):Doc10.
38. 38. Douglas AH, Acharya SP, Allery LA. Communication skills teaching and learning in Nepal; what are medical students’ perceptions and experiences? A qualitative study. BMC Med Educ [Internet]. 29 Ekim 2020 [a.yer 28 Ağustos 2024];20(1):391. Erişim adresi: https://doi.org/10.1186/s12909-020-02330-y
39. 39. Gonullu I, Atasay B, Erden S, Gokmen D, Celik G. The Students’ Feedbacks on Comunication Skills Practices in Ankara University Faculty of Medicine/Ankara Universitesi Tip Fakultesi Ogrencilerinin Iletisim Becerileri Uygulamalarina Yonelik Geri Bildirimleri. Journal of Ankara University Faculty of Medicine [Internet]. 01 Nisan 2021 [a.yer 27 Ağustos 2024];74(1):18-27. Erişim adresi: https://go.gale.com/ps/i.do?p=AONE&sw=w&issn=13075608&v=2.1&it=r&id=GALE%7CA662833747&sid=googleScholar&linkaccess=abs
40. 40. Gebhardt C, Mehnert-Theuerkauf A, Hartung T, Zimmermann A, Glaesmer H, Götze H. COMSKIL: a communication skills training program for medical students. GMS J Med Educ [İnternet]. 15 Nisan 2021 [a.yer 28 Ağustos 2024];38(4):Doc83. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136352/
41. 41. Varma J, Prabhakaran A, Singh S. Perceived need and attitudes towards communication skill training in recently admitted undergraduate medical students. Indian J Med Ethics. 2018;3(3):196-200.
42. 42. Halac E, Quiroga D, Olmas JM, Trucchia SM. [Communication in medicine: a new and much needed curricular alternative]. Rev Fac Cien Med Univ Nac Cordoba. 2016;73(3):212-8.
43. 43. Borowczyk M, Stalmach-Przygoda A, Doroszewska A, Libura M, Chojnacka-Kuraś M, Małecki Ł, vd. Developing an effective and comprehensive communication curriculum for undergraduate medical education in Poland – the review and recommendations. BMC Med Educ [İnternet]. 07 Eylül 2023 [a.yer 28 Ağustos 2024];23:645. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10486093/
44. 44. Swinfen D, Labuschagne M, Joubert G. Student review of doctor-patient communication skills training in a South African undergraduate medical programme. African Journal of Health Professions Education [İnternet]. Eylül 2022 [a.yer 28 Ağustos 2024];14(3):115-21. Erişim adresi: https://journals.co.za/doi/full/10.7196/AJHPE.2022.v14i3.1570
45. 45. Givron H, Desseilles M. Longitudinal study: Impact of communication skills training and a traineeship on medical students’ attitudes toward communication skills. Patient Educ Couns. Nisan 2021;104(4):785-91.
46. 46. Nair BT, Negi V, Prakash A. Assessment of communication skills of interns in pediatrics using mini-clinical evaluation exercise. Sahel Medical Journal [Internet]. Eylül 2021 [a.yer 28 Ağustos 2024];24(3):134. Erişim adresi: https://journals.lww.com/shmj/fulltext/2021/24030/assessment_of_communication_skills_of_interns_in.7.aspx
47. 47. Batra P, Batra R, Verma N, Bokariya P, Garg S, Yadav S. Mini clinical evaluation exercise (Mini-CEX): A tool for assessment of residents in department of surgery. J Educ Health Promot [İnternet]. 25 Ağustos 2022 [a.yer 28 Ağustos 2024];11:253. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621368/
48. 48. Motefakker S, Shirinabadi Farahani A, Nourian M, Nasiri M, Heydari F. The impact of the evaluations made by Mini-CEX on the clinical competency of nursing students. BMC Med Educ [Internet]. 20 Ağustos 2022 [a.yer 28 Ağustos 2024];22(1):634. Erişim adresi: https://doi.org/10.1186/s12909-022-03667-2
49. 49. Khalafi A, Sharbatdar Y, Khajeali N, Haghighizadeh MH, Vaziri M. Improvement of the clinical skills of nurse anesthesia students using mini-clinical evaluation exercises in Iran: a randomized controlled study. J Educ Eval Health Prof [İnternet]. 06 Nisan 2023 [a.yer 28 Ağustos 2024];20. Erişim adresi: https://synapse.koreamed.org/articles/1516086025
50. 50. Bylund CL, Adams KA, Sinha T, Afana A, Yassin MA, El Geziry A, vd. The Impact of a Communication Skills Workshop on Doctors’ Behavior Over Time. Advances in Medical Education and Practice [İnternet]. 15 Nisan 2020 [a.yer 28 Ağustos 2024];11:289-94. Erişim adresi: https://www.tandfonline.com/doi/abs/10.2147/AMEP.S216642
51. 51. Møller JE, Henriksen J, Søjnæs C, Brøgger MN. Doctors’ experiences of earlier mandatory postgraduate communication skills training: a qualitative study. Int J Med Educ [İnternet]. 28 Şubat 2022 [a.yer 28 Ağustos 2024];13:47-55. Erişim adresi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017507/
52. 52. Terzioğlu C, Ayhan F. Öğrenci Hemşire Gözünden İletişim Becerileri Dersinin Değişime Katkısı. TJHR [İnternet]. 21 Ağustos 2023 [a.yer 27 Ağustos 2024];4(2):1-12. Erişim adresi: https://dergipark.org.tr/en/pub/tjhr/issue/79469/1276037
53. 53. Gude T, Finset A, Anvik T, Bærheim A, Fasmer OB, Grimstad H, vd. Do medical students and young physicians assess reliably their self-efficacy regarding communication skills? A prospective study from end of medical school until end of internship. BMC Med Educ [Internet]. 30 Haziran 2017 [a.yer 27 Ağustos 2024];17(1):107. Erişim adresi: https://doi.org/10.1186/s12909-017-0943-y