Baernstein Amy, Fryer-Edwards Kelly
Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
Acad Med. 2003 Jul;78(7):742-7. doi: 10.1097/00001888-200307000-00018.
To determine whether writing, one-on-one interviews with faculty, or a combination of these interventions effectively elicited reflection on professionalism for medical students.
The study was a randomized trial conducted in 2001 at Harborview Medical Center, Seattle, Washington, with fourth-year medical students on a four-week clinical clerkship in emergency medicine. Three interventions were evaluated: the critical incident report (CIR), the CIR followed by a one-on-one interview with a faculty member, and one-on-one interview with no CIR. Quality and quantity of professional issues raised were addressed.
All students (n = 68) agreed to participate; 66 completed the study components. On average, the students addressed significantly more issues of professionalism in their interviews alone than in their CIRs, 15.9 (95% confidence interval [CI] 18.2-13.6) and 7.15 (CI 8.88-5.40) issues respectively (p <.0001). Interviews preceded by CIRs were not significantly different from interviews with no CIR (13.5 versus 15.9 professionalism issues raised, respectively). In-depth explorations, including problem solving and projection to the future, occurred 2.59 times in interviews alone (CI 3.62-1.56) and 0.794 times in CIRs (CI 1.12-0.46) (p <.001). When analyzed as a proportion of total statements, the groups had similar ratios of in-depth statements (11.2% in CIRs and 15.7% in interviews alone).
Writing did not significantly affect the quantity or quality of reflection in interviews. One-on-one interviews with a faculty mentor most effectively elicited reflection on professionalism. Future studies should examine how reflective exercises such as those evaluated can be used to promote professional development.
确定写作、与教员进行一对一访谈或这些干预措施的组合是否能有效地促使医学生对职业素养进行反思。
该研究于2001年在华盛顿州西雅图市的哈博维尤医疗中心进行，是一项随机试验，对象为正在进行为期四周急诊医学临床实习的四年级医学生。评估了三种干预措施：关键事件报告（CIR）、CIR后与教员进行一对一访谈以及无CIR的一对一访谈。探讨了所提出的专业问题的质量和数量。
所有学生（n = 68）均同意参与；66名学生完成了研究内容。平均而言，学生在单独访谈中提及的职业素养问题显著多于在CIR中提及的问题，分别为15.9个（95%置信区间[CI] 18.2 - 13.6）和7.15个（CI 8.88 - 5.40）问题（p <.0001）。有CIR的访谈与无CIR的访谈没有显著差异（分别提出13.5个和15.9个职业素养问题）。深入探讨，包括解决问题和对未来的预测，在单独访谈中出现2.59次（CI 3.62 - 1.56），在CIR中出现0.794次（CI 1.12 - 0.46）（p <.001）。当作为总陈述的比例进行分析时，各小组的深入陈述比例相似（CIR中为11.2%，单独访谈中为15.7%）。
写作对访谈中反思的数量或质量没有显著影响。与教员导师进行一对一访谈最有效地促使了对职业素养的反思。未来的研究应考察如何利用诸如本研究评估的那些反思练习来促进职业发展。
