Chittenden Eva H, Henry Duncan, Saxena Varun, Loeser Helen, O'Sullivan Patricia S
Palliative Care Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
Acad Med. 2009 Jul;84(7):872-6. doi: 10.1097/ACM.0b013e3181a815e9.
Starting clerkships is anxiety provoking for medical students. To ease the transition from preclerkship to clerkship curricula, schools offer classroom-based courses which may not be the best model for preparing learners. Drawing from workplace learning theory, the authors developed a seven-day transitional clerkship (TC) in 2007 at the University of California, San Francisco School of Medicine in which students spent half of the course in the hospital, learning routines and logistics of the wards along with their roles and responsibilities as members of ward teams. Twice, they admitted and followed a patient into the next day as part of a shadow team that had no patient-care responsibilities. Dedicated preceptors gave feedback on oral presentations and patient write-ups. Satisfaction with the TC was higher than with the previous year's classroom-based course. TC students felt clearer about their roles and more confident in their abilities as third-year students compared with previous students. TC students continued to rate the transitional course highly after their first clinical rotation. Preceptors were enthusiastic about the course and expressed willingness to commit to future TC preceptorships. The transitional course models an approach to translating workplace learning theory into practice and demonstrates improved satisfaction, better understanding of roles, and increased confidence among new third-year students.
对于医学生来说，开始临床实习会引发焦虑情绪。为了缓解从临床前课程到临床课程的过渡，学校提供基于课堂的课程，但这可能不是培养学习者的最佳模式。基于工作场所学习理论，作者于2007年在加利福尼亚大学旧金山分校医学院开发了一个为期七天的过渡性临床实习（TC）项目，学生在该课程的一半时间里待在医院，学习病房的日常工作和后勤事务，以及他们作为病房团队成员的角色和职责。他们两次作为影子团队的一员接收并跟踪一名患者至次日，影子团队不承担患者护理责任。专门的带教老师会对口头报告和患者记录给出反馈。学生对TC的满意度高于上一年基于课堂的课程。与之前的学生相比，TC学生作为三年级学生对自己的角色更清晰，对自己的能力更有信心。TC学生在第一次临床轮转后仍对过渡课程给予高度评价。带教老师对该课程充满热情，并表示愿意在未来担任TC带教工作。这个过渡课程为将工作场所学习理论转化为实践提供了一种模式，并显示出满意度提高、对角色有更好的理解以及新三年级学生的信心增强。
