University of Manchester Medical School, Manchester M6 8HD, UK.
Med Educ. 2009 Nov;43(11):1036-43. doi: 10.1111/j.1365-2923.2009.03508.x.
This study aimed to explore how medical students experience contacts with real patients and what they learn from them.
We carried out a post hoc, single-group study in one teaching sector of a 5-year, problem-based, horizontally integrated, outcome-based and community-oriented undergraduate programme, in which students lacked clinical exposure in the pre-clerkship phase. Subjects comprised five cohorts of students on their first clerkships. Data consisted of purposively selected, voluntary, self-report statements regarding real patient learning (RPL). Constant comparative analysis was performed by two independent researchers.
Respondents valued patients as an instructional resource that made learning more real. They reported learning through visual pattern recognition as well as through dialogue and physical examination. They more often used social than professional language to describe RPL. They reported affective outcomes including enhanced confidence, motivation, satisfaction and a sense of professional identity. They also reported cognitive outcomes including perspective, context, a temporal dimension, and an appreciation of complexity. Real patient learning helped respondents link theory learned earlier with reality as represented by verbal, visual and auditory experiences. It made learning easier, more meaningful and more focused. It helped respondents acquire complex skills and knowledge. Above all, RPL helped learners to remember subject matter. Most negative responses concerned the difficulty of acquiring appropriate experience, but RPL made a minority of respondents feel uncomfortable and incompetent.
Real patient learning led to a rich variety of learning outcomes, of which at least some medical students showed high metacognitive awareness. Sensitivity from clinical mentors towards the positive and negative outcomes of RPL reported here could support reflective clinical learning.
本研究旨在探讨医学生如何与真实患者接触以及从中学到什么。
我们在一个为期 5 年的、以问题为基础的、横向整合的、以结果为导向的和面向社区的本科课程的一个教学单元中进行了事后、单组研究，在这个课程中，学生在预科阶段没有临床接触。研究对象包括五个首次实习的学生队列。数据由关于真实患者学习（RPL）的有目的选择的、自愿的、自我报告的陈述组成。两名独立的研究人员进行了恒定性比较分析。
受访者将患者视为教学资源，使学习更加真实。他们通过视觉模式识别以及通过对话和体检来学习。他们更多地使用社交语言而不是专业语言来描述 RPL。他们报告了情感结果，包括增强信心、动力、满意度和职业认同感。他们还报告了认知结果，包括视角、背景、时间维度和对复杂性的欣赏。真实患者学习帮助受访者将早期学到的理论与口头、视觉和听觉经验所代表的现实联系起来。它使学习变得更容易、更有意义、更集中。它帮助受访者获得复杂的技能和知识。最重要的是，RPL 帮助学习者记住主题。大多数负面反应涉及获得适当经验的困难，但 RPL 使少数受访者感到不舒服和无能。
真实患者学习带来了丰富多样的学习成果，其中至少有一些医学生表现出了高度的元认知意识。临床导师对这里报告的 RPL 的积极和消极结果的敏感性可以支持反思性临床学习。
