West Donald A, Nierenberg David W
Dartmouth Medical School, Psychiatry, DHMC -Psychiatry Level 2, # 1 Medical Center Dr., Lebanon, NH 03756, USA.
Acad Psychiatry. 2009 May-Jun;33(3):204-11. doi: 10.1176/appi.ap.33.3.204.
The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and communications skills, professionalism, practice-based learning and improvement, and system-based practice. The authors aim to understand how students are learning and growing in these domains and to modify the clerkship in an ongoing manner.
Data were collected from the Dartmouth Medical Encounter Documentation System (DMEDS) for all student encounters in required third-year psychiatry clerkships during academic years 2004-2007, in which students had intensive involvement in patient care.
One hundred seventy three students reported a total of 4,676 patient encounters, averaging 27.2 encounters per student and 1.8 psychiatric diagnoses per patient. Students met "learning targets" for anxiety disorder, bipolar affective disorder, depression, personality disorder (borderline), posttraumatic stress disorder, psychosis, schizophrenia, and substance abuse (alcohol), but not for disorders more likely seen in outpatient settings. For the 10 counseling skills learning targets, students only met those for family issues. In the four "newer" competency domains, students reported struggling with issues in 0.3% to 12.6% of encounters. Students documented being challenged by professionalism issues most often and recorded examples of how these competencies played out for them during the clerkship.
Use of a required web-based medical encounter reporting system for student-patient-faculty encounters during a psychiatry clerkship can be of significant value in assessing what students are seeing, doing, and learning on this required third-year experience. The results provide helpful current information to the clerkship director and data that help the director modify the clerkship on an ongoing basis to better meet students' educational needs.
作者回顾了在一个基于网络的系统中记录的、为期三年的必修精神病学实习期间医学生的诊疗情况，该系统涵盖六个广泛的能力领域（类似于毕业后医学教育认证委员会推荐的领域）。这些用于确定所诊治患者的诊断、所练习的临床技能以及在人际和沟通技能、职业素养、基于实践的学习与改进以及基于系统的实践方面的经历。作者旨在了解学生在这些领域是如何学习和成长的，并持续改进实习安排。
从达特茅斯医学诊疗记录系统（DMEDS）收集了2004 - 2007学年必修的三年级精神病学实习期间所有学生诊疗情况的数据，在此期间学生深度参与患者护理。
173名学生共报告了4676次患者诊疗情况，平均每名学生27.2次诊疗，每名患者1.8个精神科诊断。学生达到了焦虑症、双相情感障碍、抑郁症、人格障碍（边缘型）、创伤后应激障碍、精神病、精神分裂症和物质滥用（酒精）的“学习目标”，但未达到门诊环境中更常见疾病的目标。对于10项咨询技能学习目标，学生仅达到了家庭问题方面的目标。在四个“更新的”能力领域中，学生报告在0.3%至12.6%的诊疗中遇到问题。学生记录最多的是职业素养问题带来的挑战，并记录了这些能力在实习期间对他们产生影响的实例。
在精神病学实习期间，使用基于网络的必修医学诊疗报告系统记录学生 - 患者 - 教员的诊疗情况，对于评估学生在这一必修的三年级实习经历中所诊治的患者、所做的事情以及所学内容具有重要价值。研究结果为实习主任提供了有用的当前信息，以及有助于主任持续改进实习安排以更好满足学生教育需求的数据。
