Sanson-Fisher R W, Rolfe I E, Jones P, Ringland C, Agrez M
Faculty of Medicine and Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
Med Educ. 2002 Nov;36(11):1028-34. doi: 10.1046/j.1365-2923.2002.01334.x.
To describe and evaluate the effectiveness of a new method of teaching clinical skills designed to increase students' active and self-directed learning as well as tutor feedback.
A total of 22 consenting Year 4 medical students undertaking general practice and general surgery clinical experience were involved in a pre- and post-test research design. In the initial period of the study, students were taught clinical skills in a traditional manner. In the second phase a clinical teaching strategy called systematic clinical appraisal and learning (SCAL) was utilised. This learning strategy involved active and self-directed learning, holistic care and immediate feedback. Students independently saw a patient and were asked to make judgements about the patient's potential diagnosis, tests required, management, psychosocial needs, preventive health requirements, and any ethical problems. These judgements were then compared with those of the clinical supervisor, who saw the same patient independently. Students recorded details for each consultation. Comparisons were made of the two study periods to examine whether the use of SCAL increased the number of students' independent judgements, perceived student learning, tutor feedback and self-directed learning.
During the SCAL learning period, students reported making a greater number of statistically significant independent judgements, and receiving significantly increased tutor feedback in both general practice and general surgery. The number of learning goals set by students was not found to differ between the two periods in surgery but significantly increased in general practice in the SCAL period. Students' perceptions of their learning significantly increased in the SCAL period in surgery but not in general practice. During the traditional learning period in both settings, there was limited student decision-making about most aspects of care, but particularly those relating to prevention, psychosocial issues and ethics.
The SCAL approach appears to offer some advantages over traditional clinical skills teaching. It appears to encourage active and independent decision-making, and to increase tutor feedback. Further exploration of the approach appears warranted.
描述并评估一种旨在增强学生主动和自主学习以及教师反馈的临床技能教学新方法的有效性。
共有22名同意参与的四年级医学生参与了一项前后测研究设计，他们正在进行全科和普通外科临床实习。在研究初期，学生以传统方式学习临床技能。在第二阶段，采用了一种名为系统临床评估与学习（SCAL）的临床教学策略。这种学习策略包括主动和自主学习、整体护理以及即时反馈。学生独立接诊一名患者，并被要求对患者的潜在诊断、所需检查、治疗、心理社会需求、预防保健要求以及任何伦理问题做出判断。然后将这些判断与独立接诊同一名患者的临床带教老师的判断进行比较。学生记录每次会诊的详细情况。对两个研究阶段进行比较，以检验SCAL的使用是否增加了学生的独立判断数量、学生的学习感知、教师反馈以及自主学习。
在SCAL学习阶段，学生报告称在全科和普通外科中做出了更多具有统计学意义的独立判断，并且收到的教师反馈显著增加。在外科中，两个阶段学生设定的学习目标数量没有差异，但在SCAL阶段全科中显著增加。在外科中，学生对自己学习的感知在SCAL阶段显著增加，但在全科中没有。在两种环境下的传统学习阶段，学生在护理的大多数方面，尤其是与预防、心理社会问题和伦理相关的方面，决策有限。
SCAL方法似乎比传统临床技能教学具有一些优势。它似乎鼓励主动和独立决策，并增加教师反馈。对该方法进行进一步探索似乎是有必要的。
