Webb Travis P, Aprahamian Charles, Weigelt John A, Brasel Karen J
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Curr Surg. 2006 Nov-Dec;63(6):444-7. doi: 10.1016/j.cursur.2006.04.001.
Time constraints on the teaching and evaluation of residents continue to alter the way in which medical knowledge must be imparted and assessed. Lifelong learning is a component of the practice-based learning competency. A portfolio is one way to assess practice-based learning, but its use is unfamiliar to most surgical programs. The authors describe the evolution of the Surgical Learning and Instructional Portfolio (SLIP) into a worthwhile educational tool.
In March 2001, the authors began a program to encourage residents to develop a case-based portfolio to document their experience and demonstrate acquisition of knowledge in caring for a variety of surgical diseases. The monthly case topic was chosen by the resident and reported using a template: case history, supporting diagnostic studies, differential diagnosis, final diagnosis with ICD-9 coding, management options, treatment used, 3 lessons learned, embellishment of 1 lesson, and 2 articles supporting the experience. Initially, cases were submitted to the program coordinator and reviewed every 6 months with a faculty advisor to provide feedback.
After the first 18 months of this program, resident compliance was less than 50%, satisfaction was low, and formal review did not occur. In July 2004, a single faculty member became responsible for evaluating and providing feedback on the monthly SLIPs. The assignments were handled electronically with feedback delivered within the month via e-mail. SLIP quality as measured by resident compliance and satisfaction improved.
These SLIPs have matured into a valuable educational tool satisfying multiple ACGME competencies. This portfolio system required direct faculty feedback to become successful.
住院医师教学与评估的时间限制不断改变医学知识传授和评估的方式。终身学习是基于实践的学习能力的一个组成部分。档案袋是评估基于实践的学习的一种方式，但大多数外科项目对其使用并不熟悉。作者描述了外科学习与教学档案袋（SLIP）如何演变成一种有价值的教育工具。
2001年3月，作者启动了一个项目，鼓励住院医师建立一个基于病例的档案袋，记录他们的经验，并展示在护理各种外科疾病过程中知识的获取情况。每月的病例主题由住院医师选择，并使用模板进行报告：病史、辅助诊断研究、鉴别诊断、带有ICD - 9编码的最终诊断、管理选项、所采用的治疗方法、吸取的3个经验教训、对1个经验教训的阐述以及2篇支持该经验的文章。最初，病例提交给项目协调员，每6个月由一名教员顾问进行审查以提供反馈。
在该项目的前18个月，住院医师的依从性低于50%，满意度较低，且未进行正式审查。2004年7月，一名教员负责评估每月的SLIP并提供反馈。任务通过电子方式处理，反馈在当月通过电子邮件发送。以住院医师依从性和满意度衡量的SLIP质量有所提高。
这些SLIP已发展成为一种有价值的教育工具，满足了多个毕业后医学教育认证委员会（ACGME）的能力要求。这个档案袋系统需要教员的直接反馈才能取得成功。
