Prunuske Jacob P, Deci David M
Department of Family Medicine and Community Health, University of Minnesota Medical School Duluth, Duluth, MN 55812-3031, USA.
Fam Med. 2013 Mar;45(3):193-6.
Students provide variable feedback on instructional quality at ambulatory training sites. We hypothesized several strengths and weaknesses of placing students at resident and non-resident training sites, including differences in faculty behaviors, patient characteristics, work environment, learning opportunities, and levels of student engagement. We systematically assessed for differences in learning quality between clerkship sites with and without residents.
Students completed the MedED IQ, a validated survey assessing four domains of instructional quality, after completing a required primary care rotation. We calculated descriptive and summary statistics and two sample tests of proportion analyzing student agreement with each MedEd IQ item with respect to the presence or absence of resident learners.
Of 149 total, 113 (75.8%) students completed the MedEd IQ site survey. A greater percentage of students at resident training sites (25.8%) than at non-resident sites (7.3%) agreed with the statement "The opportunities were too diverse, preventing me from developing proficiency." A greater percentage of students at resident training sites (19.4%) than at non-resident sites (1.2%) agreed with the statement "The health care team was not supportive of my learning." There were no differences between sites with or without residents on 14 items measuring preceptor actions or seven items measuring student involvement.
Ambulatory clerkship sites with and without residents provide comparable quality learning experiences and precepting. Students placed at resident training sites may be overwhelmed with diverse opportunities and have a less supportive learning environment than students placed at non-resident sites. Future research should evaluate the impact of health care team development programs designed to foster a more supportive training environment for medical students. Ways of aligning residency and medical student education goals within the training setting should be explored.
学生对门诊培训地点的教学质量反馈不一。我们推测了将学生安排在住院医师培训地点和非住院医师培训地点的若干优缺点，包括教员行为、患者特征、工作环境、学习机会以及学生参与度的差异。我们系统评估了有住院医师和无住院医师的实习地点在学习质量上的差异。
学生在完成必修的初级保健轮转后，完成了MedED IQ，这是一项经过验证的调查，评估教学质量的四个领域。我们计算了描述性和汇总统计数据，以及两个样本比例检验，分析学生对每个MedEd IQ项目关于是否有住院医师学习者的认同情况。
在总共149名学生中，113名（75.8%）完成了MedEd IQ实习地点调查。住院医师培训地点的学生中，同意“机会太多样化，妨碍我提高熟练程度”这一说法的比例（25.8%）高于非住院医师培训地点的学生（7.3%）。住院医师培训地点的学生中，同意“医疗团队不支持我的学习”这一说法的比例（19.4%）高于非住院医师培训地点的学生（1.2%）。在衡量带教老师行为的14个项目或衡量学生参与度的7个项目上，有住院医师和无住院医师的实习地点之间没有差异。
有住院医师和无住院医师的门诊实习地点提供了质量相当的学习体验和带教。与安排在非住院医师培训地点的学生相比，安排在住院医师培训地点的学生可能会因机会多样而应接不暇，且学习环境的支持度较低。未来的研究应评估旨在为医学生营造更具支持性培训环境的医疗团队发展项目的影响。应探索在培训环境中使住院医师培训和医学生教育目标保持一致的方法。
