Department of Medicine, University of California, San Francisco, School of Medicine, and Veterans Affairs Medical Center, San Francisco, California 94121, USA.
Acad Med. 2011 Dec;86(12):1560-5. doi: 10.1097/ACM.0b013e31823595fd.
The value of continuity in medical education, particularly during clerkships, is increasingly recognized. Previous clerkship-based models have described changes that emphasize continuity in patient care, learner supervision, and curriculum. The creation of continuous student peer groups can foster interactions that enhance mutual support through uncomfortable professional transitions during the clerkship years. Here, the authors describe a third-year clerkship model based at the San Francisco Veterans Affairs (VA) Medical Center called VA Longitudinal Rotations (VALOR), designed explicitly to establish a supportive learning environment for small peer groups.Seven groups of medical students (42 total) completed VALOR across three academic years between 2007 and 2009. On clerkships during VALOR, one hour per week was designated for faculty-facilitated sessions amongst peer groups. Students' perceptions of peer group support and overall program satisfaction were determined with immediate post surveys and focus groups at the end of VALOR, and with follow-up surveys 5 to 27 months after completing VALOR. Students strongly valued several elements of VALOR peer groups, including support through clerkship challenges, meeting for facilitated reflection, and appreciating patient experiences across the continuum of care. Students' appreciation for their peer group experiences persisted well after the conclusion of VALOR. VALOR students performed the same as or better than traditional clerkship students on knowledge and skill-based outcomes. The authors demonstrate that their third-year clerkship program using peer groups has built supportive learning networks and facilitated reflection, allowing students to develop critical professional skills. Student communication around patient care was also feasible and highly valued.
医学教育中连续性的价值，特别是在实习期间，越来越受到重视。以前基于实习的模式描述了强调患者护理、学习者监督和课程连续性的变化。创建连续的学生同伴群体可以促进互动，通过实习期间的不舒适的职业过渡来增强相互支持。在这里，作者描述了一种名为 VA 纵向旋转（VALOR）的第三年实习模式，该模式是在旧金山退伍军人事务部（VA）医疗中心设立的，旨在为小的同伴群体建立一个支持性的学习环境。在 2007 年至 2009 年的三个学年中，有七个医学学生小组（共 42 人）完成了 VALOR。在 VALOR 实习期间，每周安排一小时进行教师在同伴群体之间进行的辅导。学生对同伴群体支持的看法和对整个项目的满意度通过 VALOR 结束时的即时调查和焦点小组以及 VALOR 完成后 5 至 27 个月的后续调查来确定。学生非常重视 VALOR 同伴群体的几个要素，包括通过实习挑战提供支持、进行有针对性的反思以及欣赏整个护理过程中的患者体验。学生对他们的同伴群体体验的欣赏在 VALOR 结束后很长一段时间内仍然存在。VALOR 学生在知识和技能方面的表现与传统实习学生一样好，甚至更好。作者证明，他们使用同伴群体的第三年实习课程建立了支持性的学习网络并促进了反思，使学生能够发展关键的专业技能。围绕患者护理的学生沟通也是可行的，并且受到高度重视。
