Smith Sherilyn, Fryer-Edwards Kelly, Diekema Douglas S, Braddock Clarence H
Department of Pediatrics, University of Washington School of Medicine, Seattle 98195, USA.
Acad Med. 2004 Mar;79(3):265-71. doi: 10.1097/00001888-200403000-00015.
To compare the effects of two teaching methods (written case analyses and written case analyses with group discussion) on students' recognition and assessment of common ethical dilemmas.
In 1999-2000, all third-year students at the University of Washington School of Medicine on a pediatrics clinical rotation participated in the study. Eighty students were based in Seattle and 66 were in community sites in a five-state area. All students received three scenarios with written instructions for ethical analysis, submitted written answers, and received written feedback from a single evaluator. The Seattle students also participated in an hour-long, one-time discussion group about the cases. All students submitted a final case analysis. Four components of the case analyses were evaluated: ability to identify ethical issues, see multiple viewpoints, formulate an action plan, and justify their actions. One investigator evaluated a masked subset of the case analyses from both groups to assess whether teaching method affected the students' ability to recognize and assess ethical problems.
Forty-eight of 146 available case analysis sets (each set included three initial analyses plus one final analysis) were masked and coded. Performances on the initial analyses were similar in both groups (p >.2-.8). The discussion group had a higher absolute increase in total score (p =.017) and in ability to formulate a plan (p =.013) on the final case analysis. Performances otherwise remained largely similar.
Students' recognition and assessment of ethical issues in pediatrics improves following a case-based exercise with structured feedback. Group discussion may optimize the learning experience and increase students' satisfaction.
比较两种教学方法（书面病例分析和书面病例分析加小组讨论）对学生识别和评估常见伦理困境的影响。
1999 - 2000年，华盛顿大学医学院所有参加儿科临床轮转的三年级学生参与了该研究。80名学生在西雅图，66名学生在五个州地区的社区地点。所有学生都收到三个配有伦理分析书面说明的案例，提交书面答案，并从一名评估者那里收到书面反馈。西雅图的学生还参加了一个为期一小时的关于这些案例的一次性讨论小组。所有学生都提交了一份最终病例分析。对病例分析的四个组成部分进行了评估：识别伦理问题的能力、考虑多种观点的能力、制定行动计划的能力以及为自己的行为辩护的能力。一名研究者对两组中经过盲法处理的一部分病例分析进行评估，以确定教学方法是否影响学生识别和评估伦理问题的能力。
在146份可用的病例分析集（每套包括三份初始分析加一份最终分析）中，有48份经过盲法处理并编码。两组在初始分析中的表现相似（p>.2 -.8）。在最终病例分析中，讨论组的总分绝对增幅更高（p = 0.017），制定计划的能力增幅也更高（p = 0.013）。其他方面的表现基本保持相似。
通过基于案例的练习并给予结构化反馈后，学生对儿科伦理问题的识别和评估能力有所提高。小组讨论可能会优化学习体验并提高学生的满意度。
