Irby David M, Aagaard Eva, Teherani Arianne
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco 94143-0410, USA.
Acad Med. 2004 Jan;79(1):50-5. doi: 10.1097/00001888-200401000-00012.
This study examined the teaching points made by preceptors in response to two videotaped teaching encounters to determine if (1) different preceptors use similar teaching points in response to the same case, (2) preceptors' teaching points vary by case, and (3) preceptors' teaching points vary by teaching model (One-Minute Preceptor and traditional preceptor models).
Preceptors (n = 116) at seven universities participated in a within-groups experimental design study in 2000. The preceptors viewed videotaped encounters depicting two cases and two precepting models. They were asked to list two teaching points after viewing the initial case presentations and after the teaching encounters were completed. Frequency of teaching points listed by preceptors was examined for each case and teaching model. Teaching points were coded using qualitative methods and then analyzed using repeated-measures analysis of variance.
Of the 843 total teaching points identified by preceptors, 63 were discrete teaching points that were aggregated into 15 categories. Most preceptors (82%) listed three to five separate teaching points, which varied significantly by case and model. Those observing the traditional precepting model were more likely to teach generic skills such as history-taking skills, presentation skills, and risk factors, and those observing the One-Minute Preceptor were more likely to teach about the illness focusing on a broader differential diagnosis, further diagnostic tests, and the natural presentation of disease.
Preceptors use three to five common teaching points that vary by case and teaching model. The One-Minute Preceptor model shifted teaching points away from generic clinical skills toward disease-specific teaching.
本研究考察了带教老师针对两段教学录像中的教学场景所提出的教学要点，以确定：（1）不同的带教老师针对同一病例是否使用相似的教学要点；（2）带教老师的教学要点是否因病例而异；（3）带教老师的教学要点是否因教学模式（一分钟带教模式和传统带教模式）而异。
2000年，七所大学的带教老师（n = 116）参与了一项组内实验设计研究。带教老师观看了描绘两个病例和两种带教模式的录像教学场景。要求他们在观看初始病例展示后以及教学场景结束后列出两个教学要点。对每个病例和教学模式，考察带教老师列出的教学要点的频率。使用定性方法对教学要点进行编码，然后采用重复测量方差分析进行分析。
在带教老师确定的总共843个教学要点中，63个是离散的教学要点，被归为15类。大多数带教老师（82%）列出了三到五个不同的教学要点，这些要点因病例和模式而有显著差异。观察传统带教模式的老师更有可能教授一般技能，如病史采集技能、陈述技能和危险因素，而观察一分钟带教模式的老师更有可能教授关于疾病的知识，重点是更广泛的鉴别诊断、进一步的诊断测试以及疾病的自然表现。
带教老师使用三到五个常见的教学要点，这些要点因病例和教学模式而异。一分钟带教模式将教学要点从一般临床技能转向了针对特定疾病的教学。
