Pender F T, de Looy A E
Department of Biological Sciences, University College Chester, Parkgate Road, Chester, UK.
J Hum Nutr Diet. 2004 Feb;17(1):17-24. doi: 10.1046/j.1365-277x.2003.00474.x.
One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise (Howe, 2002). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE).
The learning experience of the student was altered to accommodate a more conceptually-driven, problem-centred, case-based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students.
The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty-one (57%) students returned the post-OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed.
The Project Team was confident with the novel approach taken in re-designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.
当代医护专业人员教育的最重要要求之一是建立一个理论与实践的框架，以培养出足以支撑一生实践的专业能力（豪，2002年）。对于预注册营养师的教育而言，这带来了挑战，即要为学生提供创新课程，使其能获得适当水平的知识与理解，并注重技能和态度的培养。本研究的目的是让预注册学生在临床实习前有机会练习关键临床技能，并使用客观结构化临床考试（OSCE）模式测试技能掌握情况。
改变学生的学习体验，采用更具概念驱动、以问题为中心、基于案例的方法。调整课程，纳入一个简短的临床技能项目，该项目刻意强调技能获取。在这个临床技能项目结束时，且在学生进入临床实习之前，使用OSCE对学生的技能表现进行测试。学生也对测试方法进行了评估。
OSCE面向37名临床前学生进行。4名考生（11%）至少在一个技能领域不及格：这些学生在临床实习期间表现类似。21名（57%）学生返回了OSCE后的问卷。20名（95%）学生报告有积极体验；20名（95%）学生报告最初感到焦虑，但随着测试进行焦虑减轻。
项目团队对重新设计课程所采用的新方法充满信心：包括设立专门的临床技能项目，以及增加使用OSCE模式对临床技能进行测试。这些课程变化被认为是对学生体验的非常合适的补充，有助于在临床实习前确定学生的技能表现。
