Mainhard M Tim, van den Hurk Marianne M, van de Wiel Margaretha W J, Crebolder Harry F J M, Scherpbier Albert J J A
Centre for the Innovation of Education (CINOP), The Netherlands.
Med Educ. 2004 Dec;38(12):1236-43. doi: 10.1111/j.1365-2929.2004.02016.x.
At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an 'Adoption Programme', where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme.
Data from the evaluation questionnaires of 188 medical students were used to test a causal model of learning in the programme. A distinction was made between 'action' and 'reflection on action'. We examined the relationships between perceived instructiveness (the programme's value as a learning experience) and the following variables: comprehensibility; feasibility and execution of the assignments; time spent on the assignments, and the direct and indirect influences of the hosting general practitioner (GP) and the practical medical coaching group.
Performing the assignments had little effect on perceived instructiveness. Coaching by the hosting GP influenced the execution of assignments mainly by its effect on feasibility. Coaching by the GP and in the practical medical coaching groups barely affected perceived instructiveness.
The model gives insight into the contribution of aspects of the Adoption Programme to student learning. The results are probably negatively influenced by the insufficient priority given to the Adoption Programme in the practical medical coaching groups and by inadequate instruction given to the GPs for the purposes of their coaching role. More careful planning of patient-related assignments is recommended. Reflection on assignments and feedback on procedures are needed to lift practical experience onto a higher educational level.
在马斯特里赫特大学，一项“采用计划”促进了临床前医学教育中知识、技能和态度的融合，该计划让学生在全科医疗环境中完成任务。这些任务在实际医学辅导小组中进行讲解和讨论。本研究的目的是检验该计划中影响学习的各要素之间的关系。
使用188名医学生评估问卷的数据来测试该计划中的学习因果模型。区分了“行动”和“对行动的反思”。我们研究了感知到的指导性（该计划作为学习体验的价值）与以下变量之间的关系：可理解性；任务的可行性和执行情况；花在任务上的时间，以及接待全科医生（GP）和实际医学辅导小组的直接和间接影响。
完成任务对感知到的指导性影响不大。接待GP的辅导主要通过对可行性的影响来影响任务的执行。GP的辅导和实际医学辅导小组的辅导对感知到的指导性几乎没有影响。
该模型深入了解了采用计划各方面对学生学习的贡献。结果可能受到实际医学辅导小组对采用计划重视不足以及对GP辅导角色指导不足的负面影响。建议更仔细地规划与患者相关的任务。需要对任务进行反思并对程序进行反馈，以将实践经验提升到更高的教育水平。
