Small Risa M, Soriano Rainier P, Chietero Michael, Quintana Judith, Parkas Valerie, Koestler Jennifer
Department of Medical Education, Mount Sinai School of Medicine, New York, USA.
Educ Health (Abingdon). 2008 Dec;21(3):192. Epub 2008 Dec 15.
The preclinical years of undergraduate medical education provide educational content in a structured learning environment whereas clerkships provide clinical training in a more experiential manner. Although early clinical skills training is emphasized in many medical schools, students still feel unprepared and anxious about starting their clerkships. This study identifies the skills medical students perceive as essential and those skill areas students are most anxious about prior to starting clerkship rotations.
Open-ended questionnaires were administered to two cohorts of students, preclinical students (PCS) completing their second year and clinical students (CS) in the ninth month of the clinical training of their third year at a single urban US medical school. The following questions were addressed in the survey: which three clinical skills do they perceive are most essential for the clerkships; which skills are students most anxious about as they enter clerkships; and what additional skills training should be provided to students to ease the transition into clerkships.
Response rate to the questionnaire was 84%. PCS (n=93) reported the three most essential skills to be prepared for clerkships are: history taking/physical examination (73%), proficiency in oral case presentations (56%), and generation of differential diagnosis (46%). CS (n=105) reported interpersonal skills (80%), history taking/physical examination (37%), and time management (26%) as most essential. PCS were most anxious about their oral case presentation skills (30%), but CS were most concerned about time management and self care (40%).
This study identified the skills that students at one school regard as most important to have mastered before beginning clerkship training and the areas students find most anxiety provoking before and after they make the transition into clerkships. These results can inform medical educators about needed curriculum to facilitate this transition and decrease the anxiety of students entering the clinical realm.
本科医学教育的临床前几年在结构化学习环境中提供教育内容，而临床实习则以更具实践性的方式提供临床培训。尽管许多医学院校都强调早期临床技能培训，但学生们在开始临床实习时仍感到准备不足和焦虑。本研究确定了医学生认为至关重要的技能以及在开始临床实习轮转之前学生最焦虑的技能领域。
对美国一所城市医学院的两组学生进行了开放式问卷调查，一组是完成第二年学业的临床前学生（PCS），另一组是三年级临床培训第九个月的临床学生（CS）。调查涉及以下问题：他们认为哪三项临床技能对临床实习最为重要；学生在进入临床实习时最担心哪些技能；应该为学生提供哪些额外的技能培训以帮助他们顺利过渡到临床实习。
问卷回复率为84%。PCS（n = 93）报告称，为临床实习做好准备的三项最重要技能是：病史采集/体格检查（73%）、口头病例报告熟练程度（56%）和鉴别诊断能力（46%）。CS（n = 105）报告称人际交往能力（80%）、病史采集/体格检查（37%）和时间管理（26%）最为重要。PCS最担心自己的口头病例报告技能（30%），但CS最担心时间管理和自我护理（40%）。
本研究确定了一所学校的学生在开始临床实习培训之前认为最重要的技能，以及学生在过渡到临床实习前后最感到焦虑的领域。这些结果可以为医学教育工作者提供有关所需课程的信息，以促进这种过渡并减少进入临床领域的学生的焦虑。
