Conversation analysis（CA） in micro-sociology has been widely applied in the research field of physician-patient interaction. The purpose of this paper is to review CA literature on bad news delivery in the clinical setting and conduct a meta-analysis of relevant publications. Our literature search suggested that recent work on doctor-patient bad news delivery was dominated by CA studies from the micro perspective, thus we identified 20 eligible papers, all published by Douglas Maynard and his colleagues. Since 1991, they have conducted research in developmental disability clinics, oncology clinics, internal medicine clinics, and Acquired Immune Deficiency Syndrome counseling and testing clinics in the United States, where researchers collected and systematically analyzed audio and video data of doctor-patient conversations. This paper reviewed the characteristics and classical models of bad news delivery from the perspective of CA, thereby providing practical guidelines and references for healthcare workers.

“重复”是话语研究的重要话题,分析医患交流中的重复可以体现出医患的地位与关系.参考会话分析研究方法,纳入了28篇真实场景下生殖医学诊所的医患和护患对话,对其中的“重复”现象进行了分析和解读.用ATLAS.ti定性分析软件对会话中的“重复主体”、“重复功能”等进行分级编码,呈现出各类重复在会话中的分布情况,再现了医生和患者所采用的不同重复类型.揭示了对话中医患双方之间的话语权以及知识不对等关系,并为改善医生和患者的言语沟通提出了相应的建议,以帮助双方更有效地开展交流、建立更好的医患关系.

近年来,医患交流中的坏消息告知逐渐成为医学、社会学、语言学等领域的跨学科研究热点.坏消息告知历来被认为是医务人员在临床工作中遇到的最具有挑战性的沟通情境.文章回顾了国内外医患交流坏消息告知相关研究.主要发现有:从研究主题和内容来看,目前世界范围内医患交流坏消息告知研究多数围绕癌症患者和临终患者群体展开,研究范式可以被划分为"宏观话语外围研究"和"微观话语本体研究"两大类;来自医学学科的"宏观话语外围研究"占比较大,且已经在坏消息告知环境、告知模式、患者对坏消息告知的喜好等方面取得了较为系统、实用的研究结果,并在一定程度上取得了跨文化、跨地域的共性发现;以语言学和会话分析为代表的"微观话语本体研究"从20世纪90年代起逐渐在国外产生一定的影响,而在中国则是在20年后才刚刚起步.微观话语研究有望从跨学科角度揭示并探讨坏消息告知会话的序列结构和话轮设计;宏观与微观视角研究相结合有望为临床医务人员提供直观、具体、实用的言语层面的指导.基于上述回顾,文章对未来相关研究提出了建议和展望.

目的 了解中国2型糖尿病患者掌握的糖尿病相关知识、获取信息的渠道,并呈现患者管理糖尿病的方法、效果和经验.方法 选取38例中国2型糖尿病患者,对其进行一对一半结构式深入访谈,鼓励患者展开疾病叙事.结果 ①患者首次确诊糖尿病呈现出四种情形和三种心理回应模式;②患者对糖尿病的病症成因尚缺乏了解,但对治疗方法较熟悉;获悉途径从单一到多元渠道分布不均;③多数患者采纳了“服药、运动、饮食”三种基本的管理模式,但对疾病管理实施和效果尚不满意.结论 糖尿病改变了患者的生活,疾病管理的本质是配合药物治疗、调整生活方式;患者有强烈的治愈疾病的愿望,但需得到当前社会环境、医疗水平、医患交流以及自我疾病和情绪管理等社会、机构和个人层面的有机配合,从而实现对糖尿病的有效管理和控制.

睡眠是受睡眠—觉醒中枢主动调节的一种周期性可逆静息现象,是人类日常生活中最熟悉的生命活动之一.睡眠质量是个睡眠时相持续时间、睡眠深度及睡眠效果协调一致的综合体现[1].护士作为特殊的职业群体,护理工作是一种专业性很强并以特殊人群为服务对象的工作,长期的生物钟紊乱及各方面压力给护理人员带来了不同程度的睡眠问题,也影响了护理工作的效率和安全,已成为社会广泛关注的公共卫生问题[2].为保障临床安全,制定相应的干预措施改善临床护士的睡眠质量提供理论依据,现就护士睡眠质量的现状、影响因素及其改善对策综述如下.

It is necessary for medical educators to understand how medical students construct their identities after entering medical schools and what the influencing factors are in this process.By using the personality and social structure perspective model,this research did a qualitative analysis of medical students' construction of professional identity based on 92 parallel charts written by graduate students majoring in clinical medicine.This study shows that writing parallel charts has positive effect on medical students' professional identity construction.It also provides some implications on improving medical education by using narrative medicine and parallel charts.

In recent years,doctor-patient conflicts occurred frequently in China.It is crucially important to raise medical students' awareness and understanding on the nature of doctor-patient communication and improve their communicative competences.In order to investigate the current situation of communication between doctors and patients of chronic diseases and generate implications on teaching medical students about doctor-patient communication,this study explored type 2 diabetes patients' perceptions and expectations of their communication with doctors.16 Chinese diabetes type 2 patients were enrolled.Semi-structured one-to-one in-depth interviews were conducted.Subjects were encouraged to expand their narration on communication with their doctors.Interview results shows that patients' general evaluation on doctor-patient communication is positive,however dissatisfaction exists in areas including the contemporary medical system,medical advancement,doctor competence,doctor' s attitudes,and manner of communication.It is concluded that communication between diabetes type 2 patients and their doctors is found problematic in two aspects:task-focused behaviors are in need of refinement and enrichment,as the current information exchange is found to be far from enough;the social-emotional behaviors are totally neglected in communication.Suggestions on educating medical students and improving their communication competences are generated from the study.

Objectives To optimize the curriculum for better education quality. Methods By literature review, the curriculum of the bio-medical English program of Peking University was summa-rized. Interviews were conducted on 8 sophomores of the program based on convenience sampling for their concerns over the curriculum and a questionnalre was designed based on such concerns. Ques-tionnalre survey was used for the remarks and suggestions of the 129 graduates of year 2002, 2003 and 2004 on the curriculum, with 79 valid questionnalres collected and the data analyzed by Microsoft Excel. Results Respectively 64 (81.02%), 52 (65.82%), 53 (67.09%) respondents believe the se-quence, duration and connection of the English courses are appropriate and 65 (82.27%), 46 (58.22%), 50 (63.29%) respondents believe the sequence, duration and connection of the medical courses are appropriate. 63 (81.77%) respondents hoped that they could do experiments in the medical courses, but 18 of them (23.08%) worried that the experiments would make the curriculum more tense. 71 (89.97%) respondents thought that the internship at hospital in the curriculum was conducive to better understanding of medical course contents . Suggestions on the improvement of the curriculum were also made by respondents. Conclusions The curriculum could be further optimized, especially on the connection between different courses, although most of the respondents by and large believe that the curriculum of the program is rational and hold positive attitude towards the internship in hospital and experiments in the curriculum.

Objective To implement and explore the effect of RICH Research-based and Cooperative Learning in intensive reading courses for Biomedical English majors.Methods 31 students from 2009 Biomedical English majors at Health Science Center of Peking University were selected."Contemporary College English Ⅱ" was used as the text book.Research-based and Cooperative Learning activities were designed and conducted.Classroom observation,audio-recording,and group interview were carried out to collect feedback for and evaluation on the activity.Results All subjects were satisfied with the Research-based and Cooperative Learning activity.They reported that their command of English language and understanding of western culture and humanistic quality have improved.Conclusions RICH Research-based and Cooperative Learning is effective in improving the quality of intensive reading courses and assists the development of learner autonomy.However,the design and implementation of the approach should be refined so as to further improve the teaching effect.

This paper presented the first stage of a reform project on Intensive Reading course for Biomedical English majors at Health Science Center of Peking University.Through a critical analysis and review of the theoretical basis and basic components of RICH model,the paper proposed to construct an RICH(X) model.The model is further discussed and explored and the first stage of the case from the above mentioned project is presented.Implications on adopting RICH model in English courses are drawn.Suggestions on constructing an RICH(X) model are provided.