Lester-Smith David, Campbell Dianne E, Elliott Elizabeth J
Discipline of Paediatrics and Child Health, University of Sydney and The Children's Hospital at Westmead, Sydney, NSW, Australia.
J Paediatr Child Health. 2010 May;46(5):262-7. doi: 10.1111/j.1440-1754.2009.01682.x. Epub 2010 Mar 22.
To develop and evaluate a novel skills-based education programme for medical students completing a paediatric pre-internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini-clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff.
We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need-based assessment of out-of-hours junior doctors' tasks. Students rated their level of confidence prior to and after the tutorial and following the OCE. Students provided structured and free text feedback on the programme.
Of 29 PrInt students (2007-2008), with collectively 85 tutorial attendances, 84% rated the programme excellent (39%) or very good (45%). For each topic students' confidence increased after the tutorial and again after the OCE (P < 0.001). Improvement was most marked for skills for which students rated themselves pre-teaching as having poor confidence (pain management and calculation of rehydration fluids). Overall, the proportion with 'high' confidence increased from 8.2% pre-tutorial to 38.8% post-tutorial and 72.9% post-OCE (P < 0.001). Competence in skills was assessed by OCE and all students achieved scores of >90%. Diaries from junior doctors during 20 shifts at the CHW recorded 398 out-of-hours activities, the most common of which are ordering intravenous fluids (19.6%), reviewing asthmatics (16.6%) and recharting medications (16.3%).
PrInt students value structured teaching incorporating OCE, which allows assessment of clinical skills and direct formative feedback and promotes gains in confidence, knowledge and skills. Addition of OCE to the teaching programme significantly increased the confidence of PrInt students in performing specific tasks compared with an educational session alone. Local needs assessment of junior doctors by out-of-hours survey both confirmed selection of appropriate topics (pain, fluids) and informed additional topics (asthma management and bronchodilator weaning regime) for future PrInt student programmes.
为在悉尼韦斯特米德儿童医院（CHW）完成儿科实习前培训（PrInt）的医学生开发并评估一个全新的基于技能的教育项目，该项目纳入了迷你临床评估练习形式的形成性评估部分，并基于对初级员工的本地需求评估。
我们设计了一个教学项目，其中包括四个互动教程以及使用观察临床练习（OCE）的形成性评估任务。最终项目是根据对非工作时间初级医生任务的本地需求评估制定的。学生在教程前后以及OCE之后对自己的信心水平进行评分。学生对该项目提供了结构化和自由文本反馈。
在29名PrInt学生（2007 - 2008年）中，他们总共参加了85次教程，84%的学生将该项目评为优秀（39%）或非常好（45%）。对于每个主题，学生在教程后以及OCE之后信心都有所增强（P < 0.001）。对于那些学生在预教学时自评信心较差的技能（疼痛管理和补液计算），提高最为显著。总体而言，“高”信心水平的比例从教程前的8.2%增加到教程后的38.8%以及OCE后的72.9%（P < 0.001）。技能能力通过OCE进行评估，所有学生的得分均>90%。CHW的初级医生在20个班次的工作日记记录了398项非工作时间活动，其中最常见的是开具静脉输液（19.6%）、复查哮喘患者（16.6%）和重新记录用药情况（16.3%）。
PrInt学生重视包含OCE的结构化教学，这使得能够评估临床技能并提供直接的形成性反馈，促进信心、知识和技能的提升。与仅进行教育课程相比，在教学项目中增加OCE显著提高了PrInt学生执行特定任务的信心。通过非工作时间调查对初级医生进行本地需求评估，既确认了对适当主题（疼痛、液体）的选择，也为未来PrInt学生项目提供了其他主题（哮喘管理和支气管扩张剂撤药方案）的信息。
