Hastings Am, McKinley R K, Fraser R C
Department of Medical and Social Care Education, University of Leicester, Leicester, UK.
Med Educ. 2006 May;40(5):437-43. doi: 10.1111/j.1365-2929.2006.02445.x.
This paper seeks to describe the consultation strengths and weaknesses of senior medical students, the explicit and prioritised strategies for improvement utilised in student feedback, and curriculum developments informed by this work.
Prospective, descriptive study of students on clinical placements in general practice. All were observed directly by 2 assessors in consultation with 5 patients in a general practice setting. Performance was judged against 5 categories of consultation competence and 35 component competences as contained in a modified version of the Leicester Assessment Package. Specific strategies for improvement were selected from a list of 69 previously formulated strategies.
Data from 1116 students were included. The consultation competences identified most frequently as strengths related to interpersonal skills, while weaknesses were mainly in the domain of clinical problem-solving. The median number of key strengths identified per student was 5, with 5 additional but lesser strengths. A median of 3 key and lesser weaknesses were identified. The average number of strategies selected to address an identified weakness was 1.2. Students rated the assessment process and its impact very positively.
The systematic assessment of the consultation competence of medical students by direct observation involving real patients is feasible and facilitates the 'educational diagnosis' of individuals and of their peer group. It has informed development of teaching and generated research hypotheses.
本文旨在描述高年级医学生问诊的优势与不足、学生反馈中明确且优先采用的改进策略，以及基于此项工作的课程发展情况。
对参与全科临床实习的学生进行前瞻性描述性研究。两名评估者在全科医疗环境中直接观察所有学生与5名患者的问诊情况。根据莱斯特评估包修改版中的5类问诊能力和35项分项能力对学生表现进行评判。从之前制定的69项策略列表中选取具体的改进策略。
纳入了1116名学生的数据。最常被认定为优势的问诊能力与人际沟通技巧相关，而不足之处主要在临床问题解决方面。每名学生被认定的关键优势中位数为5项，另有5项次要优势。被认定的关键和次要不足中位数为3项。针对已确定不足所选择的策略平均数量为1.2项。学生对评估过程及其影响给予了非常积极的评价。
通过涉及真实患者的直接观察对医学生问诊能力进行系统评估是可行的，有助于对个体及其同龄群体进行“教育诊断”。它为教学发展提供了依据并产生了研究假设。
