Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Acad Med. 2011 Sep;86(9):1130-6. doi: 10.1097/ACM.0b013e31822519d4.
Early clinical experiences that are integrated with basic/clinical science content are considered beneficial to medical students, but little has been published concerning how to accomplish this. In this article, the authors describe the yearlong Advanced Doctoring course, a multidisciplinary clinical skills course for second-year students that was implemented at Mayo Medical School in 2006-2007. Of 197 course hours, 163 (83%) are integrated with the basic/clinical science curriculum, which is organized into six blocks (e.g., circulation, oxygen). During most blocks, all second-year students (approximately 50) participate in integrated clinical, surgical, diagnostic, and simulation experiences related to the basic/clinical science block's content. In the circulation block, for example, students complete workups on inpatients with chest pain, examine inpatients and outpatients with heart murmurs, review pediatric presentations of shock, observe valve replacement in the operating room, observe an echocardiogram, and participate in a simulation (i.e., Harvey heart sounds). Student feedback on course evaluation forms is highly positive. Further, on the 2009 Association of American Medical Colleges Graduation Questionnaire, graduating Mayo medical students were twice as likely as U.S. medical students nationally to strongly agree that the basic science content was sufficiently integrated and had sufficient illustrations of clinical relevance. The authors propose that the Advanced Doctoring course may be a useful model for other institutions contemplating curricular reform that targets better integration of formal knowledge and clinical experiences.
早期的临床经验与基础/临床科学内容相结合被认为对医学生有益，但关于如何实现这一目标的文献却很少。本文作者介绍了为期一年的高级行医课程，这是一门面向二年级学生的多学科临床技能课程，于 2006-2007 年在梅奥医学院实施。在 197 个课时中，有 163 个（83%）与基础/临床科学课程相结合，这些课程被组织成六个模块（例如循环、氧气）。在大多数模块中，所有二年级学生（约 50 人）都参与与基础/临床科学模块内容相关的综合临床、外科、诊断和模拟体验。例如，在循环模块中，学生对胸痛的住院患者进行检查，对有心脏杂音的住院患者和门诊患者进行检查，复习儿科休克表现，观察手术室的瓣膜置换术，观察超声心动图，并参与模拟（即 Harvey 心音）。学生对课程评估表的反馈非常积极。此外，在 2009 年美国医学协会毕业问卷调查中，梅奥医学院的应届毕业生比全美医学生更有可能强烈同意基础科学内容得到了充分的整合，并充分说明了临床相关性。作者提出，高级行医课程可能是其他考虑课程改革的机构的一个有用模式，这些机构的目标是更好地整合正式知识和临床经验。
