O'Brien Bridget, Cooke Molly, Irby David M
The Carnegie Foundation for the Advancement of Teaching, Stanford, California 94305, USA.
Acad Med. 2007 Oct;82(10):970-8. doi: 10.1097/ACM.0b013e31814a4fd5.
To explore the congruence between students' and clerkship directors' perceptions and attributions of students' struggles during the transition to clerkships.
Focus groups and interviews were conducted with third- and fourth-year medical students and clerkship directors at 10 U.S. medical schools in 2005 and 2006. Schools were selected to represent diverse locations, sizes, and missions. Interviews and focus groups were recorded, transcribed, and analyzed thematically.
Students' struggles included understanding roles and responsibilities, adjusting to clinical cultures, performing clinical skills, learning the logistics of clinical settings, and encountering frequent changes in staff, settings, and content. Clerkship directors recognized students' struggles with roles and responsibilities, performing clinical skills, and adjusting to clinical cultures, but they also focused on students' difficulties applying knowledge to clinical reasoning and engaging in self-directed learning.
Clerkship directors and students recognize many challenges associated with learning and performing in the clerkships. Students' perspectives suggest that these challenges may be more complex than clerkship directors and clinical teachers realize and/or are capable of addressing. The areas in which clerkship directors' and students' perspectives are not congruent point to directions for future research that can guide curricula and teaching strategies.
探讨学生与临床实习主任对于学生在向临床实习过渡期间所面临困难的认知与归因之间的一致性。
2005年和2006年，在美国10所医学院校，对三、四年级医学生以及临床实习主任进行了焦点小组访谈。所选学校代表了不同的地理位置、规模和使命。访谈和焦点小组讨论进行了录音、转录并进行主题分析。
学生面临的困难包括理解角色和职责、适应临床文化、掌握临床技能、了解临床环境的后勤安排，以及工作人员、环境和内容的频繁变化。临床实习主任认识到学生在角色和职责、掌握临床技能以及适应临床文化方面存在困难，但他们也关注学生在将知识应用于临床推理和进行自主学习方面的困难。
临床实习主任和学生认识到与临床实习学习和实践相关的许多挑战。学生的观点表明，这些挑战可能比临床实习主任和临床教师意识到的及/或能够解决的更为复杂。临床实习主任和学生观点不一致的领域为未来研究指明了方向，可指导课程设置和教学策略。
