Chen H Carrie, Sheu Leslie, O'Sullivan Patricia, Ten Cate Olle, Teherani Arianne
Department of Paediatrics, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Med Educ. 2014 Feb;48(2):136-45. doi: 10.1111/medu.12316.
Given the calls for earlier student engagement in clinical experiences, educators are challenged to define roles for pre-clerkship students that enable legitimate participation in clinical practice. This study aimed to determine the student roles and activities, as well as the clinic characteristics, that allow early student engagement within a specific clinical experience.
The authors conducted semi-structured interviews in December 2011 and January 2012 with a purposive sample of medical student and faculty volunteers at student-run clinics (SRCs). They were asked to discuss and compare student roles in SRCs with those in the core curriculum. An inductive approach and iterative process were used to analyse the interview transcripts. Themes identified from initial open coding were organised using the sensitising concepts of workplace learning and communities of practice and subsequently applied to code all transcripts.
A total of 22 medical students and four faculty advisors were interviewed. Thematic analysis revealed pre-clerkship student roles in direct patient care (patient triage, history and physical examinations, patient education, laboratory and immunisation procedures) and in clinic management (patient follow-up, staff management, quality improvement). Students took ownership of patients and occupied central roles in the function of the clinic, with faculty staff serving as peripheral resources. Clinic-related features supporting this degree of legitimate participation included defined scopes of practice, limited presenting illnesses, focused student training, and clear protocols and operations manuals.
Pre-clerkship students are capable of legitimately participating in patient care experiences to an extent not usually available to them. The SRC represents one example of how early clinical experiences in the core curriculum might be transformed through the provision of patient care activities of narrow scope.
鉴于呼吁让学生更早地参与临床实践，教育工作者面临着为见习前学生定义角色的挑战，以使他们能够合法地参与临床实践。本研究旨在确定在特定临床实践中能让学生早期参与的学生角色和活动，以及诊所特征。
作者于2011年12月和2012年1月对学生运营诊所（SRC）的医学生和教师志愿者进行了半结构化访谈。他们被要求讨论并比较SRC中学生的角色与核心课程中的角色。采用归纳法和迭代过程对访谈记录进行分析。从初始开放编码中确定的主题使用工作场所学习和实践社区的敏感概念进行组织，随后应用于对所有记录进行编码。
共采访了22名医学生和4名教师顾问。主题分析揭示了见习前学生在直接患者护理（患者分诊、病史和体格检查、患者教育、实验室和免疫程序）以及诊所管理（患者随访、人员管理、质量改进）方面的角色。学生对患者负责，并在诊所运作中占据核心地位，教师作为外围资源。支持这种合法参与程度的与诊所相关的特征包括明确的实践范围、有限的就诊疾病、针对性的学生培训以及清晰的规程和操作手册。
见习前学生能够在一定程度上合法地参与患者护理体验，而这在通常情况下是他们无法做到的。SRC代表了一种通过提供范围狭窄的患者护理活动来转变核心课程早期临床体验的方式。
