医学专业知识对医疗场景下共情程度表现的影响

发布时间：2018-06-13 07:45

本文选题：共情 + 医学　；参考：《天津师范大学》2017年硕士论文

【摘要】：共情(empathy)是指在面对他人情绪场景时,能够自发地感受到他人情绪,并对他人的情绪状态产生认知评估及相应行为反应的过程。已有大量研究发现,医疗从业者相比于普通个体,在医疗场景下对疼痛的共情程度较低。但对该现象的解释仍存在争议。有多项研究证实,专业知识会影响到个体的关注的线索,而关注的线索会影响个体的共情能力。因此我们认为,可能是医疗训练影响到被试在医学环境中的关注的线索,从而影响到医学专业人员在医疗场景下的共情表现程度。本研究试图通过两项实验,进一步明确医学从业者对疼痛共情程度发生减弱的原因。在本研究中,通过IRI-C量表评价个体在一般情景下的共情能力,使用实验任务中的评分衡量医疗场景下的共情表现,同时使用fNIRS记录被试在发生共情时的脑功能变化。实验1旨在验证医学从业者与普通群体在疼痛共情上的差异。研究请19名普通大学生被试与16名针灸专业学生观看医疗场景图片,请被试对看到的图片进行疼痛等级评定并使用fNIRS监测脑血氧变化,实验后使用量表评估一般共情能力。结果发现,(1)医学被试与非医学被试在共情量表上的得分无显著差异,(2)在对图片中人物的疼痛程度进行评分时,医学专业被试与非医学专业被试之间存在显著的差异,医学专业学生评分更低,(3)使用fNIRS监测被试的脑血氧变化,医学专业被试相比非医学专业被试,在背外侧前额叶区域的激活程度存在显著差异,表明这两类被试在情绪控制功能上的显著差异。为了确认这种差异产生的原因,我们设计了实验2,旨在通过控制变量的方法,确定共情相关脑机制变化的影响因素。在实验2中,请16名非医学专业院校被试完成数图中针数、寻找骨性标志、判断疼痛程度三种任务,控制非医学被试观看针灸图片的线索,并对他们的脑活动进行监测。实验前,先对被试进行短时间的医学专业知识(骨性标志)培训。结果发现,在被试进行数针任务与寻找骨性标志任务时,脑激活模式与医学专业被试的差异,相比评价疼痛任务中的差异更小。研究证明了当被试的关注的线索发生改变时,其引起的脑激活模式会发生明显的改变,而与医学专业知识的相关的关注的线索改变,会使被试的脑激活模式更趋近与医学专业被试。上述两项实验共同可以证明以下结论:(1)医学专业人员在医疗情景下更不容易感受患者的疼痛感。(2)医学专业人员在医疗场景中的共情表现降低,与他们观察患者时所关注的线索有关。(3)医学专业人员在医疗场景中共情表现的降低,还可能是长期医疗训练与从业经验所引起的。
[Abstract]:Empathy refers to the process of cognitive evaluation and corresponding behavioral response to the emotional state of others when they are faced with the emotional scene of others and can feel the emotions of others spontaneously. A large number of studies have found that medical practitioners are less sympathetic to pain in medical settings than the average individual. However, the explanation of this phenomenon is still controversial. A number of studies have confirmed that professional knowledge affects individual cues of concern and attention cues affect an individual's ability to empathize. Therefore, we think that medical training may affect the clues of the subjects' attention in the medical environment, and thus affect the degree of empathy of medical professionals in the medical environment. Through two experiments, this study attempts to further clarify the reasons for the decline in the degree of empathy for pain among medical practitioners. In this study, IRI-C scale was used to evaluate the empathy ability of individuals in general situations, the scores in the experiment task were used to measure the empathy performance in medical scenarios, and the changes of brain function were recorded by using fNIRS. Experiment 1 was designed to verify the differences in pain empathy between medical practitioners and the general population. 19 college students and 16 students majoring in acupuncture and moxibustion were asked to view the images of the medical scene. The pain grade of the images was evaluated and the changes of cerebral blood oxygen were monitored by fNIRS. After the experiment, the general empathy ability was evaluated by using the scale. The results showed that (1) there was no significant difference in the scores between medical and non-medical subjects on the scale of empathy. 2) there was a significant difference between the subjects majoring in medicine and those of non-medical majors when the pain degree of the characters in the picture was evaluated. FNIRS was used to monitor the changes of cerebral blood oxygen. There was a significant difference in the activation degree in the dorsolateral prefrontal lobe area between the medical majors and the non-medical majors. The results showed that there was significant difference in emotion control function between the two groups. In order to confirm the cause of this difference, we designed experiment 2 to determine the influencing factors of the changes of empathy-related brain mechanism by controlling variables. In experiment 2, 16 non-medical college subjects were asked to complete the needle count, search for bony marks, judge the degree of pain, control the clues of acupuncture and moxibustion pictures, and monitor their brain activity. Prior to the experiment, the subjects were trained in medical knowledge (bone markers) for a short period of time. The results showed that the difference between brain activation mode and medical subjects was smaller than that in evaluating pain task. Studies have shown that when the subjects' cues of concern change, the brain activation patterns that they cause change significantly, while those related to medical expertise change. It will bring the brain activation model closer to that of the medical subjects. Together, the two experiments prove that medical professionals are less likely to feel patients' pain in a medical setting) and that medical professionals have less empathy in a medical setting. The decline of medical professionals in the medical scene may also be caused by long-term medical training and professional experience.
【学位授予单位】：天津师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B842

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