Bagenal Jessamy, Barber Zoe, Sahnan Kapil, Handa Ashok
Department of Surgery, John Radcliffe Hospital, Oxford Deanery, 48 New High Street,Oxford, UK.
Clin Teach. 2011 Sep;8(3):160-3. doi: 10.1111/j.1743-498X.2011.00443.x.
Day-case surgery, theatre direct admissions and elective surgery have revolutionised the surgical patient's pathway, and have minimised the length of their hospital stay. However, with large numbers of medical students placed mostly at teaching hospitals, this has also significantly reduced students' exposure to clinical signs in surgery. This study aimed to assess whether the preoperative assessment clinic would be an appropriate teaching arena to offer medical students exposure to clinical signs.
Junior doctors assigned to the preoperative assessment clinic were asked to fill out a specially designed questionnaire for each patient they reviewed. This included the planned operation, presenting complaint, and identification and categorisation of objective clinical signs on examination. The assessor was asked whether the patient was suitable for, and amenable to, having medical students observe. The presenting complaints and clinical signs were referenced to the curriculum for Oxford University's second Bachelor of Medicine examinations (finals).
Of the 100 patients seen in 40 clinics, only four refused to be seen by a medical student. Of the remaining patients, 89 (92%) had presenting complaints listed on the core curriculum for Oxford University. Seventy-six (79%) patients had objective clinical signs on examination. Only three patients (3%) had neither clinical signs nor core relevant presenting complaints.
The results clearly demonstrate that preoperative assessment is an arena that would give medical students two important opportunities: to examine objective clinical signs and to take histories of presenting complaints from the core curriculum. This learning opportunity would otherwise be missed.
日间手术、手术室直接收治患者及择期手术彻底改变了外科患者的就医流程，并将其住院时间减至最短。然而，由于大量医学生大多被安排在教学医院，这也显著减少了他们接触外科临床体征的机会。本研究旨在评估术前评估门诊是否是一个能让医学生接触临床体征的合适教学场所。
被分配到术前评估门诊的低年资医生被要求为他们诊治的每位患者填写一份专门设计的问卷。这包括计划进行的手术、主诉以及检查时客观临床体征的识别和分类。评估者被问及该患者是否适合且愿意让医学生观摩。主诉和临床体征均参考牛津大学医学第二学士学位考试（期末考试）的课程大纲。
在40个门诊中诊治的100例患者中，只有4例拒绝让医学生诊治。在其余患者中，89例（92%）的主诉列在牛津大学的核心课程大纲上。76例（79%）患者在检查时有客观临床体征。只有3例患者（3%）既无临床体征也无核心相关主诉。
结果清楚地表明，术前评估是一个能为医学生提供两个重要机会的场所：检查客观临床体征以及获取核心课程大纲中主诉的病史。否则将错失这个学习机会。
