Carney Patricia A, Ogrinc Greg, Harwood Beth G, Schiffman Jennifer S, Cochran Nancy
School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: FM, Portland, OR 97239, USA.
Acad Med. 2005 Dec;80(12):1153-8. doi: 10.1097/00001888-200512000-00021.
Many medical schools have revised their curricula to include longitudinal clinical training in the first and second years, placing an extra burden on academic teaching faculty and expanding the use of community-based preceptors for clinical teaching. Little is known about the impact of different learning settings on clinical skills development.
In 2002-03 and 2003-04, the authors evaluated the clinical skills of two sequential cohorts of second-year medical students at Dartmouth Medical School (n = 155) at the end of a two-year longitudinal clinical course designed to prepare them for their clerkship year. Students' objective structured clinical examination (OSCE) scores were compared on a cardiopulmonary and an endocrine case according to precepting sites (academic medical center [AMC] clinics, AMC-affiliated office-based clinics, or community-based primary care offices) and core communication, history taking, physical examination, and patient education skills were assessed. Study groups were compared using descriptive statistics and analysis of variance (mixed model).
Ninety-five students (61%) had community-based preceptors, 31 (20%) AMC clinic-based preceptors, and 29 (19%) AMC-affiliated office-based preceptors. Students' performances did not differ among clinical learning sites with overall scores in the cardiopulmonary case of 61.2% in AMC clinics, 63.3% in office-based AMC-affiliated clinics, and 64.9% in community-based offices (p = .20). Scores in the endocrine case similarly did not differ with overall scores of 65.5% in AMC clinics, 68.5% in office-based AMC-affiliated clinics, and 66.4% in community-based offices (p = .59).
Students' early clinical skill development is not influenced by educational setting. Thus, using clinicians for early clinical training in any of these settings is appropriate.
许多医学院校已修订课程，在第一年和第二年纳入纵向临床培训，这给学术教学人员带来了额外负担，并扩大了基于社区的带教教师在临床教学中的使用。关于不同学习环境对临床技能发展的影响，人们了解甚少。
在2002 - 2003年和2003 - 2004年，作者评估了达特茅斯医学院连续两届二年级医学生（n = 155）在为期两年的纵向临床课程结束时的临床技能，该课程旨在为他们的见习年做准备。根据带教地点（学术医疗中心[AMC]诊所、AMC附属的门诊诊所或基于社区的初级保健办公室）比较学生在心肺和内分泌病例上的客观结构化临床考试（OSCE）成绩，并评估核心沟通、病史采集、体格检查和患者教育技能。使用描述性统计和方差分析（混合模型）对研究组进行比较。
95名学生（61%）有基于社区的带教教师，31名（20%）有基于AMC诊所的带教教师，29名（19%）有AMC附属门诊诊所的带教教师。学生在不同临床学习地点的表现没有差异，心肺病例的总体得分在AMC诊所为61.2%，在AMC附属门诊诊所为63.3%，在基于社区的办公室为64.9%（p = 0.20）。内分泌病例的得分同样没有差异，在AMC诊所的总体得分为65.5%，在AMC附属门诊诊所为68.5%，在基于社区的办公室为66.4%（p = 0.59）。
学生早期临床技能的发展不受教育环境的影响。因此，在这些环境中的任何一种使用临床医生进行早期临床培训都是合适的。
