Centre for Medical Education, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Med Educ. 2013 Dec;47(12):1184-96. doi: 10.1111/medu.12217.
Previous research has suggested that as medical students become more senior, they should increasingly take on the roles they will enact as newly qualified doctors by contributing to patient care. However, student contribution to patient care carries inherent risks to patient safety. This study aimed to provide students with a new opportunity to contribute to patient care and to use this as a platform from which to explore the influence of contributing to patient care on medical student learning.
This study took place in the context of final-year medical student prescribing education at the University of Edinburgh, Edinburgh, UK. Students on attachment at a district general hospital were afforded a unique opportunity to learn prescribing by completing in-patient drug charts in a process termed 'pre-prescribing'. All students were invited to participate in focus groups conducted by the principal researcher. Focus group discussions were audio-recorded, transcribed verbatim and thematically analysed.
Six focus groups, each lasting 20-50 minutes, were conducted with four to seven participants (33 students in total). The emerging themes took the form of developmental outcomes and learning processes. Developmental outcomes included ability to perform the task, modification of attitudes towards the task, formation of a professional identity, and development of relationships within the team. The central feature of the experience which influenced all developmental outcomes, was making mistakes. The themes interact in complex ways and all contribute towards development as a professional.
This study has demonstrated that contributing to patient care enhances students' development as professionals. Some of these developmental outcomes, such as improvements in knowledge and skills, may be achievable to some extent within the classroom. Other changes, such as developing relationships, forming a sense of professional identity and modifying attitudes, might arguably be achievable only within the context of contributing to patient care.
之前的研究表明，随着医学生年级的升高，他们应该越来越多地承担起他们作为新合格医生的角色，为患者护理做出贡献。然而，学生对患者护理的贡献对患者安全存在固有风险。本研究旨在为学生提供一个新的机会来为患者护理做出贡献，并以此为平台探索为患者护理做出贡献对医学生学习的影响。
这项研究是在英国爱丁堡大学最后一年医学生处方教育的背景下进行的。在一家地区综合医院实习的学生有机会通过完成被称为“预处方”的住院患者药物图表来学习处方。所有学生都被邀请参加由首席研究员进行的焦点小组讨论。焦点小组讨论被录音、逐字记录并进行主题分析。
共进行了六次焦点小组讨论，每次讨论持续 20-50 分钟，有四到七名参与者（共 33 名学生）。出现的主题形式为发展结果和学习过程。发展结果包括执行任务的能力、对任务态度的改变、职业身份的形成以及团队内部关系的发展。影响所有发展结果的经验的核心特征是犯错误。这些主题以复杂的方式相互作用，都有助于专业发展。
本研究表明，为患者护理做出贡献可以增强学生作为专业人员的发展。其中一些发展结果，如知识和技能的提高，在一定程度上可能在课堂内实现。其他变化，如发展关系、形成职业认同感和改变态度，可能只有在为患者护理做出贡献的背景下才能实现。
