Fryer-Edwards Kelly, Arnold Robert M, Baile Walter, Tulsky James A, Petracca Frances, Back Anthony
Department of Medical History and Ethics, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Acad Med. 2006 Jul;81(7):638-44. doi: 10.1097/01.ACM.0000232414.43142.45.
Small-group teaching is particularly suited for complex skills such as communication. Existing work has identified the basic elements of small-group teaching, but few descriptions of higher-order teaching practices exist in the medical literature. Thus the authors developed an empirically driven and theoretically grounded model for small-group communication-skills teaching. Between 2002 and 2005, teaching observations were collected over 100 hours of direct contact time between four expert facilitators and 120 medical oncology fellows participating in Oncotalk, a semiannual, four-day retreat focused on end-of-life communication skills. The authors conducted small-group teaching observations, semistructured interviews with faculty participants, video or audio recording with transcript review, and evaluation of results by faculty participants. Teaching skills observed during the retreats included a linked set of reflective, process-oriented teaching practices: identifying a learning edge, proposing and testing hypotheses, and calibrating learner self-assessments. Based on observations and debriefings with facilitators, the authors developed a conceptual model of teaching that illustrates an iterative loop of teaching practices aimed at enhancing learners' engagement and self-efficacy. Through longitudinal, empirical observations, this project identified a set of specific teaching skills for small-group settings with applicability to other clinical teaching settings. This study extends current theory and teaching practice prescriptions by describing specific teaching practices required for effective teaching. These reflective teaching practices, while developed for communication skills training, may be useful for teaching other challenging topics such as ethics and professionalism.
小组教学特别适用于沟通等复杂技能的教学。现有研究已明确了小组教学的基本要素，但医学文献中对高阶教学实践的描述却很少。因此，作者们开发了一个基于实证且有理论依据的小组沟通技能教学模型。在2002年至2005年期间，收集了4位专家引导者与120名参与Oncotalk（一个专注于临终沟通技能的为期四天的半年一次的务虚会）的肿瘤内科住院医师之间超过100小时直接接触时间的教学观察数据。作者们进行了小组教学观察、对教师参与者的半结构化访谈、带文字记录审查的视频或音频录制以及教师参与者对结果的评估。务虚会期间观察到的教学技能包括一组相互关联的以过程为导向的反思性教学实践：确定学习边界、提出并检验假设以及校准学习者的自我评估。基于与引导者的观察和汇报，作者们开发了一个教学概念模型，该模型展示了一个旨在提高学习者参与度和自我效能的教学实践迭代循环。通过纵向的实证观察，该项目确定了一组适用于小组环境且可应用于其他临床教学环境的特定教学技能。这项研究通过描述有效教学所需的具体教学实践，扩展了当前的理论和教学实践规范。这些反思性教学实践虽然是为沟通技能培训而开发的，但可能对教授其他具有挑战性的主题（如伦理和职业素养）有用。
