一项关于老年医学家访项目对医学生老年护理知识、技能和态度影响的前瞻性对照试验。
A prospective controlled trial of the influence of a geriatrics home visit program on medical student knowledge, skills, and attitudes towards care of the elderly.
机构信息
Uniformed Services University of Health Sciences, Bethesda, MD, USA.
出版信息
J Gen Intern Med. 2009 May;24(5):599-605. doi: 10.1007/s11606-009-0945-5. Epub 2009 Mar 18.
PURPOSE
To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge.
METHODS
Using a mixed methods, prospective, controlled trial, volunteer control group students (n = 17) at two sites and intervention group students (n = 16) at two different sites within the same internal medicine clerkship were given Internet and CDROM-based geriatric self-study materials. Intervention group students identified a geriatrics patient from their clinical experience, performed one "home" visit (home, nursing home, or rehabilitation facility) to practice geriatric assessment skills, wrote a structured, reflective paper, and presented their findings in small-group teaching settings. Papers were qualitatively analyzed using the constant comparative method for themes. All students took a pre-test and post-test to measure changes in geriatrics knowledge and attitudes.
RESULTS
General attitudes towards caring for the elderly improved more in the intervention group than in the control group (9.8 vs 0.5%; p = 0.04, effect size 0.78). Medical student attitudes towards their home care training in medical school (21.7 vs 3.2%; p = 0.02, effect size 0.94) improved, as did attitudes towards time and reimbursement issues surrounding home visits (10.1 vs -0.2%; p = 0.02, effect size 0.89). Knowledge of geriatrics improved in both groups (13.4 vs 15.2% improvement; p = 0.73). Students described performing a mean of seven separate geriatric assessments (range 4-13) during the home visit. Themes that emerged from the qualitative analysis of the reflective papers added depth and understanding to the quantitative data and supported results concerning attitudinal change.
CONCLUSIONS
While all participants gained geriatrics knowledge during their internal medicine clerkship, students who performed a home visit had improved attitudes towards the elderly and described performing geriatric assessment skills. Requiring little faculty time, a geriatrics home visit program like this one may be a useful clerkship addition to foster medical students' professional growth.
目的
确定针对三年级医学生的老年医学家庭访视计划对态度、技能和知识的影响。
方法
采用混合方法、前瞻性、对照试验，在两个地点的志愿对照组学生（n = 17）和同一内科实习内两个不同地点的干预组学生（n = 16）接受基于互联网和 CDROM 的老年学自学材料。干预组学生从他们的临床经验中确定一名老年患者，进行一次“家访”（家庭、养老院或康复机构）以练习老年评估技能，撰写一份结构化、反思性论文，并在小组教学环境中介绍他们的发现。使用恒定比较法对论文进行定性分析以确定主题。所有学生都参加了前测和后测，以衡量老年医学知识和态度的变化。
结果
与对照组相比，干预组对照顾老年人的总体态度改善更多（9.8 对 0.5%；p = 0.04，效应大小 0.78）。医学生对他们在医学院的家庭护理培训的态度（21.7 对 3.2%；p = 0.02，效应大小 0.94）以及对家庭访问相关时间和报销问题的态度（10.1 对-0.2%；p = 0.02，效应大小 0.89）都有所改善。两组的老年医学知识都有所提高（分别提高了 13.4%和 15.2%；p = 0.73）。学生们在家庭访视中描述了进行了平均七次单独的老年评估（范围为 4-13 次）。从反思性论文的定性分析中出现的主题为定量数据增添了深度和理解，并支持了有关态度变化的结果。
结论
虽然所有参与者在内科实习期间都获得了老年医学知识，但进行家庭访视的学生对老年人的态度有所改善，并描述了进行老年评估技能。这种家庭访视计划需要很少的教师时间，可能是促进医学生专业成长的有用实习附加内容。
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