Andersen Rikke Sand, Hansen Rikke Pilegaard, Søndergaard Jens, Bro Flemming
The Research Unit for General Practice, University of Aarhus, Arhus, Denmark.
BMC Med Educ. 2008 Sep 5;8:43. doi: 10.1186/1472-6920-8-43.
Recent theories on adult learning recommend that learning is situated in real-life contexts. Learning is considered a continuous process in which every new experience builds on, and integrates with, previously accumulated experiences. Reviewing and reflecting on patient cases is in line with this learning approach. There has, however, been remarkably little research into how patient cases might be applied in professional education. The purpose of this article is to present family physicians' perceptions of the learning process initiated by reviewing patient cases.
Thirteen family physicians, who had all participated in a large project on cancer diagnosis in family practice (the CAP-project), currently carried out at the Research Unit for General Practice, University of Aarhus were interviewed on their experiences of reviewing patient cases. In the CAP-project family physicians (n = 467, 81%) in the County of Aarhus (640 000 inhabitants) completed 2,212 (83%) detailed questionnaires on all newly diagnosed patients with cancer encountered in their practices during a one year period (2004-2005). In order to complete the questionnaire the family physicians were required to perform a systematic case review of each patient: they had to consult their records to provide dates of symptom-presentation, investigations and treatments initiated, and reflect on previous encounters with the patients to give detailed information on his/hers knowledge of the patients' care seeking behaviour, mental health and risk factors.The purpose of this article is to present indebt interview-data on family physicians' perceptions of the learning process initiated by reviewing patient cases, and their evaluations of using patient case reviews as a learning method in family practice.
The process of reflection initiated by reviewing patient cases enabled family physicians to reconsider their clinical work procedures which potentially supported the transition from individual competence to personal capability. According to the physicians, they were not only able to identify needed changes, some reported that they were able to transform these ideas into action and do things more effectively. According to our data this transition takes place, because the learning processes initiated were based on real life experiences which equally initiated reflections on what to improve, as well as how to improve their work.
Patient case reviews initiate reflective processes providing feedback about performance in real life situations. Family physicians are in favour of patient case reviews as a learning method, because it embraces the complexities they encounter in their daily practice and is based on personal experiences.
近期有关成人学习的理论认为，学习应置于现实生活情境中。学习被视为一个持续的过程，在此过程中，每一次新的经历都建立在先前积累的经验之上，并与之融合。回顾和反思患者病例符合这种学习方法。然而，关于患者病例如何应用于专业教育的研究却非常少。本文旨在呈现家庭医生对通过回顾患者病例启动的学习过程的看法。
对13名家庭医生进行了访谈，他们都参与了一项关于家庭医疗中癌症诊断的大型项目（CAP项目），该项目目前正在奥胡斯大学全科医学研究单位开展，访谈内容是他们回顾患者病例的经历。在CAP项目中，奥胡斯郡（64万居民）的家庭医生（n = 467，81%）在一年期间（2004 - 2005年）完成了2212份（83%）关于他们在实践中遇到的所有新诊断癌症患者的详细问卷。为了完成问卷，家庭医生需要对每位患者进行系统的病例回顾：他们必须查阅记录以提供症状出现日期、检查和开始治疗的日期，并反思之前与患者的接触，以提供关于他们对患者就医行为、心理健康和风险因素了解的详细信息。本文旨在呈现关于家庭医生对通过回顾患者病例启动的学习过程的深入访谈数据，以及他们对在家庭医疗中将患者病例回顾作为一种学习方法的评价。
通过回顾患者病例启动的反思过程使家庭医生能够重新考虑他们的临床工作程序，这可能有助于从个人能力向个人才能的转变。据医生们说，他们不仅能够识别出需要做出的改变，一些人还报告说他们能够将这些想法转化为行动，并更有效地开展工作。根据我们的数据，这种转变之所以发生，是因为启动的学习过程基于现实生活经验，这些经验同样引发了对改进内容以及如何改进工作的思考。
患者病例回顾启动反思过程，提供关于现实生活中表现的反馈。家庭医生支持将患者病例回顾作为一种学习方法，因为它涵盖了他们在日常实践中遇到的复杂性，并且基于个人经验。
