Department of Medicine, Faculty of School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
Med Educ. 2011 Aug;45(8):807-17. doi: 10.1111/j.1365-2923.2011.03994.x.
This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre-clerkship clinical reasoning course.
We conducted a randomised, prospective, crossover study with Year 2 medical students taking a pre-clerkship clinical reasoning course. Students were randomised to small groups and exposed to three formats of differing instructional authenticity (paper case, DVD presentation, standardised patient [SP] presentation) across three subject areas (abdominal pain, anaemia, polyuria). Three student cohorts were taught using one instructional format per subject area so that each cohort received a different instructional format for each of the three subject areas. Outcome measures (objective structured clinical examination, video quiz, written examination) were selected to determine the effect of each instructional format on the clinical reasoning of students.
Increasingly authentic instructional formats did not significantly improve clinical reasoning performance across all outcome measures and subject areas. However, the results of the video quiz showed significant differences in the anaemia subject area between students who had been instructed using the paper case and live SP-based formats (scores of 47.4 and 57.6, respectively; p = 0.01) and in the abdominal pain subject area, in which students instructed using the DVD format scored higher than students instructed using either the paper case or SP-based formats (scores of 41.6, 34.9 and 31.2, respectively; p=0.002).
Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre-clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats.
本研究旨在探讨在预临床临床推理课程中教学形式的真实性与结果测量之间的关系。
我们对二年级医学生进行了一项随机、前瞻性、交叉研究，他们参加了预临床临床推理课程。学生被随机分配到小组中，并在三个科目领域（腹痛、贫血、多尿）中接受三种不同教学真实性的形式（纸质病例、DVD 演示、标准化患者演示）。三个学生群体分别使用一种教学形式进行教学，以便每个群体都能获得三个科目领域中的不同教学形式。选择了结果测量（客观结构化临床考试、视频测验、书面考试）来确定每种教学形式对学生临床推理的影响。
越来越真实的教学形式并没有显著提高所有结果测量和科目领域的临床推理表现。然而，视频测验的结果显示，在贫血科目领域中，使用纸质病例和现场 SP 格式教学的学生之间存在显著差异（分数分别为 47.4 和 57.6；p=0.01），在腹痛科目领域中，使用 DVD 格式教学的学生的分数高于使用纸质病例或 SP 格式教学的学生（分数分别为 41.6、34.9 和 31.2；p=0.002）。
在预临床课程中，增加教学形式的真实性似乎并没有显著提高临床推理表现。医学教育者在设计新的教学形式时，应平衡真实性的增加与认知负荷、科目领域和学习者经验等因素。
