Department of Medicine, School of Medicine, University of California, San Francisco, California 94143-0120, USA.
Acad Med. 2012 Oct;87(10):1389-96. doi: 10.1097/ACM.0b013e31826743c3.
Clerkship experiences that structure student-teacher continuity may promote learning differently than brief student-teacher relationships. The authors compared students' successful and unsuccessful teaching experiences in brief and longitudinal relationships.
A multicenter, qualitative interview study was conducted in 2009-2010 of students in two clerkship models that provide different durations of student-teacher relationships. Each student described a successful and unsuccessful teaching relationship early and late in the core clerkship year. Questions explored teachers' strategies and behaviors and students' efforts to improve unsuccessful relationships. Interview transcripts were coded to identify major themes.
Fifty-four students completed interviews. Students in brief relationships struggled to be known; students in longitudinal relationships felt respected as learners and partners. Teaching strategies differed in the two relationship durations. Questioning about factual knowledge was common in brief relationships; collaborative knowledge sharing and application to patients occurred in longitudinal relationships. Hierarchy characterized brief relationships. Longitudinal students experienced evolving expectations in response to their growing skills and contributions. Only students in longitudinal relationships described successfully intervening to improve unsuccessful relationships; students in brief relationships felt powerless.
Clerkship students in brief relationships learn to adapt to teachers' preferences and questioning to facilitate their participation and knowledge acquisition; longitudinal students experience collaborative interactions focused on their development as care providers. In longitudinal relationships, students gain confidence to influence their own learning and modify circumstances to meet their learning needs. These findings suggest that medical students' clinical experiences may be enhanced by deliberately structuring longitudinal attachments to supervisors.
结构学生-教师连续性的实习经验可能会以不同于简短的师生关系的方式促进学习。作者比较了学生在简短和纵向关系中成功和不成功的教学经验。
这是一项多中心、定性访谈研究，于 2009-2010 年在两个提供不同师生关系持续时间的实习模式中进行，对实习核心年早期和晚期的学生进行了成功和不成功的教学关系描述。问题探讨了教师的策略和行为以及学生改善不成功关系的努力。对访谈记录进行编码以确定主要主题。
54 名学生完成了访谈。在简短关系中的学生努力被了解；在纵向关系中的学生感到作为学习者和合作伙伴受到尊重。两种关系持续时间的教学策略不同。在简短关系中常见的是对事实知识的提问；在纵向关系中则是协作知识共享和应用于患者。在简短关系中存在等级制度。纵向学生经历了不断变化的期望，以回应他们不断增长的技能和贡献。只有纵向关系中的学生描述了成功干预以改善不成功的关系；在简短关系中的学生感到无能为力。
在简短关系中的实习学生学会适应教师的偏好和提问，以促进他们的参与和知识获取；纵向学生体验到以他们作为医疗服务提供者的发展为重点的协作互动。在纵向关系中，学生获得了影响自己学习和修改环境以满足学习需求的信心。这些发现表明，通过精心设计与导师的纵向联系，可能会增强医学生的临床经验。
