Diemers Agnes D, Dolmans Diana H J M, Verwijnen Maarten G M, Heineman Erik, Scherpbier Albert J J A
Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
Adv Health Sci Educ Theory Pract. 2008 Dec;13(5):633-47. doi: 10.1007/s10459-007-9070-6. Epub 2007 Jul 13.
Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students' views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients' lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.
关于为何医学生应在本科医学课程早期，即在临床前阶段就与真实患者接触，已经给出了几个理由。然而，早期与患者接触对于知识构建和临床推理技能发展的确切影响尚不清楚。我们探寻了学生对于临床前与真实患者接触对其学习、知识构建和临床推理发展的影响的看法。在一个6年制本科医学项目临床前最后一年的24名三年级学生被分成三个焦点小组，每个小组会面两次，之后达到了饱和状态。讨论内容被记录并转录。讨论总结在经过一些修改后得到了学生们的认可。使用Atlas-ti软件创建了一个编码框架，从而确定了主要主题和子主题。早期与患者接触能激励学生学习，帮助他们理解疾病对患者生活的影响，并增强职业社会化和记忆过程。学生们区分了与真实患者相关的分析性和非分析性临床推理。分析性推理涉及临床和基础科学知识。非分析性推理涉及模式识别，并且通过从不同患者接触中获得的经验学习得以实现。学生们表示，在培训早期接触真实患者对他们的学习有几个积极影响。这些接触增强了知识构建和临床推理。尽管我们的结果必须通过定量、观察性和实验性研究来验证，但它们意味着在医学教育的临床前阶段与真实患者接触能带来教育益处。
