中文版诊疗关系共情量表（CARE）用于麻醉科住院医师共情能力的评估：一项标准化病人项目的初步研究

doi:10.24920/003741

摘要/Abstract

摘要：

目的验证中文版诊疗关系共情量表（Consultation and Relational Empathy,CARE）在标准化病人模拟门诊中使用的可靠性。同时探索性地评估视频评分方式和现场评分方式之间的一致性,以及临床考官评分和标准化病人（physician-standardized patient,SP）评分之间的一致性。
方法将CARE量表的内容翻译成中文。纳入48名麻醉住院医师,在标准化病人模拟门诊中进行术前访视。每位住院医师的表现由现场考官、视频考官及SP评分员进行评分。分析不同类别评分员之间的一致性。
结果中文版CARE量表具有较高的信度（Cronbachα值为0.95）和良好的组内相关性（现场考官评分的组内相关系数为0.888,P<0.001）。尽管组内相关性良好,但视频考官的评分显著高于现场考官的评分（39.6±7.1比24.0±10,P<0.001）。Wilcoxon符号秩检验表明,基于视频评分的住院医师考核通过率显著高于现场评分的通过率（45/48比22/48,P<0.001）。SP评分与现场考官评分之间具有中度一致性（系数=0.568,P<0.001）,现场考官评分和SP评分的考核通过率之间没有显著性差异（22/48比28/48,P=0.12）。
结论中文版CARE量表能客观、准确评估麻醉术前访视中住院医师的共情能力。现场评分和视频评分之间存在一定的差异,而SP可能能够替代临床考官对住院医师的临床沟通能力进行恰当的评估。

关键词: 共情, 标准化病人模拟门诊, 评估, 评分方式

Abstract:

Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy (CARE) in physician-standardized patient (SP) encounter. We also tried to examine the agreement between video-based ratings and in-room ratings, as well as the agreement between the faculty ratings and SP ratings.
Methods The CARE was translated into Chinese. Forty-eight anesthesia residents were recruited to make preoperative interview in SP-counter. Performance of each resident was graded by in-room raters, video raters and SP raters. Consistency between different raters was examined.
Results The Chinese-CARE measure demonstrated high scale reliability with a Cronbach’s alpha value of 0.95 and high consistency in the in-room ratings in intraclass correlation (coefficient=0.888,P<0.001). Despite a good consistency in intraclass correlation, video ratings were significantly higher than in-room ratings (39.6±7.1vs. 24.0±10.0,P<0.001), and Wilcoxon signed-rank test indicated that the pass/fail rate was significantly higher based on video ratings than based on in-room ratings (45/48vs. 22/48, P<0.001). SP ratings had a moderate consistency with in-room faculty ratings (coefficient=0.568,P<0.001), and there was no significant difference between the pass/fail rates based on the in-room ratings and SP ratings (22/48vs. 28/48, P=0.12).
Conclusions The Chinese-CARE measure is reliable in the assessment of empathy during preoperative anesthesia interview. In-room and video ratings are not equivalent, while SP may provide a feasible alternative for the faculty rater in the assessment of communication skills with an appropriate measure.

Key words: empathy, standardized patient encounter, assessment, rating modality

Yahong Gong, Lijian Pei, Xia Ruan, Xu Li, Xuerong Yu, Ruiying Wang, Weijia Wang, Gang Tan, Yuguang Huang. Assessing Empathy in Anesthesia Residents with the Chinese Version of the Consultation and Relational Empathy: A Pilot Standardized Patient Program[J].Chinese Medical Sciences Journal, 2021, 36(2): 79-84.

图/表 3

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CARE measure item	Evaluation on the translation of each item
CARE measure item	Poor	Good	Perfect	Any suggestions on revision
1. Making you feel at ease
2. Letting you tell your story
3. Really listening
4. Being interested in you as a whole person
5. Fully understand your concerns
6. Showing care and compassion
7. Being positive
8. Explain things clearly
9. Helping you take control
10. Making a plan of action with you

CARE measure items	Poor (No.1/No.2)	Fair (No.1/No.2)	Good (No.1/No.2)	Very good (No.1/No.2)	Excellent (No.1/No.2)	Not applicable (No.1/No.2)	Total (No.1/No.2)
Making you feel at ease	9 (18.7)/ 6 (12.5)	14 (29.2)/ 14 (29.2)	16 (33.3)/ 13 (27.1)	6 (12.5)/ 8 (16.7)	3 (6.3)/ 7 (14.6)	0/0	48/48
Letting you tell your story	3 (6.3)/ 5 (10.4)	20 (41.7)/ 17 (35.4)	15 (31.2)/ 10 (20.8)	8 (16.7)/ 12 (25.0)	2 (4.2)/ 4 (8.3)	0/0	48/48
Really listening	13 (27.1)/ 12 (25.0)	15 (31.2)/ 8 (16.7)	12 (25.0)/ 8 (16.7)	5 (10.4)/ 12 (25.0)	3 (6.3)/ 8 (16.7)	0/0	48/48
Being interested in you as a whole person	12 (25.0)/ 13 (27.1)	15 (31.2)/ 14 (29.2)	12 (25.0)/ 12 (25.0)	7 (14.6)/ 4 (8.3)	2 (4.2)/ 5 (10.4)	0/0	48/48
Fully understand your concerns	13 (27.1)/ 9 (18.8)	18 (37.5)/ 16 (33.3)	9 (18.8)/ 13 (27.1)	5 (10.4)/ 6 (12.5)	3 (6.3)/ 4 (8.3)	0/0	48/48
Showing care and compassion	13 (27.1)/ 14 (29.2)	13 (27.1)/ 11 (22.9)	14 (29.2)/ 9 (18.8)	6 (12.5)/ 9 (18.8)	2 (4.2)/ 5 (10.4)	0/0	48/48
Being positive	12 (25.0)/ 17 (35.4)	13 (27.1)/ 13 (27.1)	13 (27.1)/ 10 (20.8)	9 (18.8)/ 4 (8.3)	1 (2.1)/ 4 (8.3)	0/0	48/48
Explain things clearly	16 (33.3)/ 11 (22.9)	16 (33.3)/ 22 (45.8)	4 (8.3)/ 3 (6.3)	8 (16.7)/ 7 (14.6)	4 (8.3)/ 5 (10.4)	0/0	48/48
Helping you take control	28 (58.3)/ 23 (47.9)	12 (25.0)/ 15 (31.2)	4 (8.3)/ 5 (10.4)	2 (4.2)/ 3 (6.3)	2 (4.2)/ 2 (4.2)	0/0	48/48
Making a plan of action with you	28 (58.3)/ 23 (47.9)	6 (12.5)/ 11 (22.9)	3 (6.3)/ 8 (16.7)	11 (22.9)/ 5 (10.4)	0 (0)/ 1 (2.1)	0/0	48/48

Items	Score (mean±SD)	Intraclass correlation
Items	Score (mean±SD)	Coefficient	P-value
In-room rater No. 1	23.2±9.7	0.888	<0.001
In-room rater No. 2	24.8±10.8	0.888	<0.001
Video rater No. 1	40.6±7.1	0.516	<0.001
Video rater No. 2	38.6±8.9	0.516	<0.001
Standardized patient rater	28.9±9.2	0.568	<0.001
Mean score of in-room raters	24.0±10.0	0.568	<0.001
Mean score of video raters	39.6±7.1	0.767	<0.001
Mean score of in-room raters	24.0±10.0	0.767	<0.001

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