Dyrbye Liselotte N, Harris Ilene, Rohren Charles H
Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, USA.
Acad Med. 2007 Oct;82(10):979-88. doi: 10.1097/ACM.0b013e318149e29c.
To gain insight into how early clinical experiences contribute to medical students' professional development.
Qualitative content analysis of second-year Mayo Medical School students' reflective journal essays pertaining to their first experiences with inpatients (from 2002 to 2004) was done using a grounded theory approach. The apprenticeship model of professional learning (knowledge and cognitive abilities, technical skills, and ethical standards) and perspectives from learning theory provided the conceptual framework. Major themes were identified, and member checking and interrater reliability was assessed to support the validity and reliability of the content analysis.
Four major themes related to the purposes that the early clinical experiences with patients served for students were identified in analysis of reflections from 76 students (participation rate 95%). The themes were issues related to relationships and learning in early encounters with hospitalized patients; integration with learning in the entire curriculum; aspects of doctoring learned; and affiliation with the physician role and professional development. Select quotes illustrate these themes and provide thick description. Member checking supported the analysis; interrater reliability was 91%.
Early hospital-based clinical experiences provide opportunities for apprenticeships in the habits of the head, hand, and heart. Medical students' growth and learning occurs within these apprenticeship domains through contextual experiential learning.
深入了解早期临床经历如何促进医学生的专业发展。
采用扎根理论方法，对梅奥医学院二年级学生关于其首次接触住院患者经历（2002年至2004年）的反思性日志文章进行定性内容分析。专业学习的学徒模式（知识与认知能力、技术技能和道德标准）以及学习理论的观点提供了概念框架。确定了主要主题，并评估了成员核对和评分者间信度，以支持内容分析的有效性和可靠性。
在对76名学生（参与率95%）的反思进行分析时，确定了与早期患者临床经历对学生所起作用相关的四个主要主题。这些主题包括在早期与住院患者接触中与关系和学习有关的问题；与整个课程学习的整合；所学医疗方面的内容；以及与医生角色和专业发展的关联。选取的引语阐释了这些主题并提供了详细描述。成员核对支持了分析结果；评分者间信度为91%。
早期以医院为基础的临床经历为头脑、双手和心灵习惯的学徒训练提供了机会。医学生的成长和学习通过情境体验式学习在这些学徒训练领域中发生。
