Department of Medicine, Massachusetts General Hospital, 02143, USA.
Med Teach. 2011;33(12):e644-50. doi: 10.3109/0142159X.2011.610844.
While numerous authors acknowledge the challenge of teaching simultaneously to medical students, interns, and residents, few offer specific advice on how to meet that challenge, and none have studied which techniques are most effective.
The purpose of this study was to determine whether multilevel teaching is challenging for attendings, whether trainees feel that teaching on rounds is appropriate to their level, and to define multilevel teaching techniques.
We surveyed attendings and trainees on the internal medicine services at two academic medical centers.
Attendings were divided about whether teaching to multiple levels posed a challenge. Trainees reported that the teaching they received was usually appropriate to their level of training. The most effective techniques for multilevel teaching were Broadening (asking "what if" questions), Targeting (directing questions at specific team members), and Novelty (teaching newly published information), while the least effective were techniques that taught advanced material unfamiliar to most or all of the team. A systematic literature review yielded no studies that focused on multilevel teaching techniques.
This article is the first to define and evaluate specific techniques for multilevel instruction in a medical setting and identifies certain techniques as more effective at engaging multiple levels of learners simultaneously.
虽然许多作者都承认同时教授医学生、实习医生和住院医师具有挑战性，但很少有人提供如何应对这一挑战的具体建议，也没有人研究过哪些技术最有效。
本研究旨在确定多层次教学是否对主治医生具有挑战性，实习医生是否认为轮班教学适合他们的水平，并定义多层次教学技术。
我们对内科学服务的主治医生和实习医生进行了调查。
主治医生对是否向多个层次教授存在挑战存在分歧。实习医生报告说，他们接受的教学通常适合他们的培训水平。多层次教学最有效的技术是拓宽（提出“如果......会怎样”的问题）、定向（将问题指向特定的团队成员）和新颖性（教授新发表的信息），而最无效的技术是教授大多数或所有团队都不熟悉的高级材料。系统文献回顾没有发现专门针对多层次教学技术的研究。
本文首次定义并评估了医学环境中多层次教学的具体技术，并确定了某些技术在同时吸引多个层次的学习者方面更有效。
