Gilbert Program in Medical Simulation, Harvard Medical School, Boston, Massachusetts 02114, USA.
Acad Med. 2010 Feb;85(2):370-7. doi: 10.1097/ACM.0b013e3181c88d74.
Flexner wanted medical students to study at the patient bedside-a remarkable innovation in his time-so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an "advanced" apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical-clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical-clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.
弗来克斯纳希望医学生在病床边学习——这在他那个时代是一项非凡的创新，以便他们能够在资深医生的密切监督下将科学应用于临床护理。自他的报告以来，医学院将课程的最后几年保留给这种“高级”学徒制，仅在基本医学科学的初始教学期后提供临床实习经验。尽管弗莱克斯纳将临床前和临床教学分开，但他致力于确保这两个领域都融入到现代医学教育中。将临床前和临床教学完全整合的愿望一直推动着医学教育改革，直到今天。在本文中，作者重新审视了临床前-临床教学顺序的最初理由，并认为现代的、增强技术的患者模拟平台在促进临床前-临床内容的同步整合方面具有独特的强大功能，这是弗莱克斯纳会赞赏的。迄今为止，医学教育工作者倾向于专注于在临床和研究生医学教育中使用增强技术的医学模拟；很少有人将大量注意力集中在使用沉浸式临床模拟在临床前学生中。作者提出了在基础医学科学教学中使用动态机器人模拟人的论点，并描述了他们在哈佛医学院使用基于模拟器的临床前教学的经验。他们讨论了这种方法的常见误解和障碍，描述了他们对该技术的课程反应，并阐明了一种认知和情感学习的统一理论，该理论拓宽了基于模拟器的医学教育的可能性、可行性和可取性的视野。
