University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden.
BMC Med Educ. 2010 Jan 28;10:9. doi: 10.1186/1472-6920-10-9.
Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.
Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.
Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.
This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.
临床教学是一种复杂的学习情境，受到学习内容、环境和参与者的行为及互动的影响。尽管人们已经进行了一些实证研究来探索临床监督是如何在真实环境中进行的，但在这方面的研究仍然很少。本研究旨在探讨在医学生的临床环境中临床教学是如何进行的。
采用民族志方法，旨在寻找临床教师管理临床教学的意义模式、相似点和差异点；在 2004 年至 2005 年的四个月期间，进行了非参与式观察和非正式访谈。研究地点在瑞典的一所教学医院，参与者是临床教师及其正在上外科课程的四年级医学生。观察是在研究目的的指导下进行的。每次观察后，都将观察记录和非正式访谈记录转录下来，所有数据资料都进行了定性分析。
发现了七种教学策略，分别是：1）问答，2）讲课，3）领航，4）提示，5）补充，6）示范，7）干预。
本研究通过描述在临床教育中使用的一整套教学策略，对以往的研究做出了贡献。研究结果表明，可以确定三种不同的、以质量为基础的教学方式，这与 Ramsden 的模式相符。这三种教学策略涵盖了不同的教学重点，要么侧重于教师的知识和行为，要么侧重于学生的行为和理解。我们认为，增加对使用策略的认识将提高临床教师的教学技能，以及他们对学生学习能力的影响。需要进一步研究这些教学策略，以验证它们对学生学习的影响。
