Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Med Educ. 2011 Mar;45(3):280-8. doi: 10.1111/j.1365-2923.2010.03861.x.
Real-patient contacts in problem-based undergraduate medical education are promoted as a good way to introduce biomedical and (in)formal clinical knowledge early in the curriculum and thereby to foster the development of coherent and integrated knowledge networks. There are concerns, however, that such contacts may cause students to focus on clinical knowledge to the neglect of biomedical knowledge, and that group discussions may be dominated by teachers. We examined these concerns by addressing the following questions in the context of group sessions in which students prepare for and report on real-patient contacts. To what extent are biomedical and (in)formal clinical knowledge addressed? To what extent are these knowledge types addressed by students or tutors? Are connections made between biomedical and clinical knowledge?
We videotaped and transcribed six preparation and six reporting group sessions (two preparation and two reporting phases for each of three groups) held with students in Year 3 of the problem-based curriculum at Maastricht University. During this year, real patients rather than paper patients are used. Qualitative analysis software was used to code propositions in the transcriptions in order to identify different kinds of knowledge and different functions of biomedical knowledge.
Formal clinical knowledge was the subject of 40.7% and 34.8% of propositions during the preparation and reporting phases, respectively. The corresponding percentages for biomedical knowledge were 15.0% and 28.0%. Tutors accounted for 63.4% of propositions during the preparation phase, and students for 80.1% during the reporting phase. Nearly all biomedical knowledge was related to clinical knowledge.
It appears that pre-clinical patient encounters can stimulate students to pay attention to both clinical and biomedical knowledge and to how they are connected. Tutor dominance was evident only during the preparation phase. Further research is needed to investigate whether pre-clinical patient contacts promote the development of coherent and integrated knowledge networks.
基于问题的本科医学教育中的真实患者接触被推广为一种在课程早期引入生物医学和（非）正式临床知识的好方法，从而促进连贯和综合知识网络的发展。然而，人们担心这种接触可能会导致学生忽视生物医学知识而只关注临床知识，并且小组讨论可能会由教师主导。我们在学生为真实患者接触做准备和报告的小组会议背景下，通过回答以下问题来研究这些问题：生物医学和（非）正式临床知识在多大程度上被涉及？学生或导师在多大程度上涉及这些知识类型？生物医学知识和临床知识之间是否有联系？
我们对马斯特里赫特大学基于问题课程的第 3 年的学生进行的六次准备和六次报告小组会议（三个小组的两个准备和两个报告阶段）进行了录像和转录。在这一年，使用真实患者而不是纸质患者。使用定性分析软件对抄本中的命题进行编码，以确定不同类型的知识和生物医学知识的不同功能。
在准备和报告阶段，正式临床知识分别占命题的 40.7%和 34.8%。生物医学知识的相应百分比分别为 15.0%和 28.0%。在准备阶段，导师占命题的 63.4%，在报告阶段，学生占 80.1%。几乎所有的生物医学知识都与临床知识有关。
似乎临床前患者接触可以激发学生关注临床和生物医学知识以及它们之间的联系。导师主导仅在准备阶段明显。需要进一步研究以调查临床前患者接触是否促进连贯和综合知识网络的发展。
