Janing J
Creighton University PreHospital Education, Omaha, Nebraska 68131, USA.
Prehosp Disaster Med. 1997 Jul-Sep;12(3):215-21.
Paramedic practice is shifting from [direct] on-line medical control to protocol-driven care initiated on the paramedic's judgment of the patient's problem(s). Teaching in most paramedic training programs remains grounded in technical rationality. This does not adequately prepare practitioners for current day practice. Medical conditions often present as ill-defined problems. To deal with these situations, practitioners need problem solving and reflective-thinking skills. Methodologies incorporating the use of these skills in a contextual situation similar to actual practice may help paramedics develop these skills.
This study sought to determine the impact of written scenario exercises in the context of clinical problems as a means of learning in order to foster higher level thinking skills and self-directed tendencies. It involved three hypotheses: 1) Post-test scores would correlate with scores attained on the traditional, multiple choice, final examination; 2) Post-test scores would correlate with scores on the critical thinking sub-test of the final examination; and 3) Scores would be better on the post-test compared to the pre-test.
This two year, longitudinal, prospective study was conducted with 55 paramedic students using a pre- and post-test. Post-test scores were compared with final examination scores and scores of the subset of higher level thinking questions within that examination using the Pearson r-test. The relationship between the pre- and post-test scores was analyzed using a one-tailed dependent t-test. Post-hoc analysis of the variables of age, experience, and education was conducted using one-way analysis of variance.
The correlation between post-test scores with final examination scores was positive and modestly significant. There was no correlation of post-test scores with sub-test scores. Comparison of pre- and post-test scores was significant. Effects for age, experience, and education were not significant statistically.
Using written scenarios increases ability to utilize reflective thinking and self-directed tendencies. However, this ability may not be demonstrated consistently on traditional written examinations. A multi-site study using large numbers and a control group or alternative methods appears to be indicated to demonstrate more accurate effects of the methodology.
护理人员的实践正在从[直接]在线医疗控制转向基于护理人员对患者问题的判断而启动的协议驱动护理。大多数护理人员培训项目的教学仍以技术合理性为基础。这并不能使从业者充分为当今的实践做好准备。医疗状况往往表现为界定不明确的问题。为了应对这些情况，从业者需要具备解决问题和反思性思维能力。在类似于实际实践的情境中运用这些技能的方法可能有助于护理人员培养这些能力。
本研究旨在确定在临床问题情境下进行书面情景练习作为一种学习方式的影响，以培养更高层次的思维能力和自我导向倾向。它涉及三个假设：1）后测分数将与传统的多项选择题期末考试成绩相关；2）后测分数将与期末考试批判性思维子测试成绩相关；3）后测成绩将优于前测成绩。
本为期两年的纵向前瞻性研究对55名护理专业学生进行了前测和后测。使用皮尔逊r检验将后测分数与期末考试成绩以及该考试中更高层次思维问题子集的分数进行比较。使用单尾相关t检验分析前测和后测分数之间的关系。使用单因素方差分析对年龄、经验和教育变量进行事后分析。
后测分数与期末考试成绩之间的相关性为正且具有适度显著性。后测分数与子测试分数之间没有相关性。前测和后测分数的比较具有显著性。年龄、经验和教育的影响在统计学上不显著。
使用书面情景可以提高运用反思性思维和自我导向倾向的能力。然而，这种能力可能无法在传统书面考试中始终如一地体现出来。似乎需要进行一项使用大量样本且设有对照组或采用替代方法的多地点研究，以证明该方法的更准确效果。
