Wilkinson Tim J, Harris Peter
Christchurch School of Medicine, New Zealand.
Med Educ. 2002 May;36(5):466-71. doi: 10.1046/j.1365-2923.2002.01209.x.
To describe the characteristics of borderline performance in final year medical students (trainee interns), as judged by their supervisors.
Qualitative study based on in-depth interviews followed by validation descriptions of borderline trainee interns identified prospectively over 12 months.
Christchurch School of Medicine, University of Otago, New Zealand.
Fourteen supervisors of trainee interns chosen because of their experience and/or close contact with trainee interns.
Analysis of supervisors' narratives to identify key themes.
Borderline trainee intern performance occurs within a transition period from clinical student to doctor and is characterised by difficulty taking on a professional role. This difficulty may be manifest by not getting involved with the health care team, poor time management and occasionally by interpersonal difficulties or not recognising limits. Taking on a professional role requires ability in the clinical task, including diagnostic ability, which is built on a foundation of basic knowledge and clinical skills. These can be influenced by personal factors such as rigidity, motivation and shyness. Personal illness can affect performance at any stage.
The difficulties faced by borderline trainee interns fit a model of transition from competence as a student to performance as an intern. A sensitive marker of such difficulties is poor time management or not getting involved with the patient care team. Such difficulties may reflect more specific problems such as professional socialization, setting priorities, hypothesis generation, assigning probabilities to identified problems, integrating competing issues, recognising limits and learning when to call for assistance.
描述医学专业最后一年学生（实习医生）表现处于及格边缘时的特征，这些特征由他们的导师评判得出。
基于深入访谈的定性研究，随后对在12个月内前瞻性确定的处于及格边缘的实习医生进行验证性描述。
新西兰奥塔哥大学基督城医学院。
挑选出14名实习医生的导师，原因是他们有经验和/或与实习医生有密切接触。
分析导师的叙述以确定关键主题。
实习医生表现处于及格边缘的情况发生在从临床学生向医生转变的过渡阶段，其特点是难以承担专业角色。这种困难可能表现为不参与医疗团队、时间管理不善，偶尔还表现为人际关系困难或没有认识到自身局限。承担专业角色需要具备临床任务能力，包括诊断能力，而这建立在基础知识和临床技能的基础之上。这些能力可能会受到个人因素的影响，如刻板、积极性和害羞等。个人疾病在任何阶段都可能影响表现。
处于及格边缘的实习医生所面临的困难符合从学生能力向实习医生表现转变的模式。这种困难的一个敏感标志是时间管理不善或不参与患者护理团队。此类困难可能反映出更具体的问题，如职业社会化、确定优先事项、提出假设、对已确定问题赋予概率、整合相互竞争的问题、认识到自身局限以及学会何时寻求帮助。
