Tofil Nancy M, Peterson Dawn Taylor, Harrington Kathy F, Perrin Brian T, Hughes Tyler, Zinkan J Lynn, Youngblood Amber Q, Bartolucci Al, White Marjorie Lee
J Grad Med Educ. 2014 Mar;6(1):127-32. doi: 10.4300/JGME-D-13-00067.1.
Simulation is an effective method for teaching clinical skills but has not been widely adopted to educate trainees about how to teach.
We evaluated a curriculum for pediatrics fellows by using high-fidelity simulation (mannequin with vital signs) to improve pedagogical skills.
The intervention included a lecture on adult learning and active-learning techniques, development of a case from the fellows' subspecialties, and teaching the case to residents and medical students. Teaching was observed by an educator using a standardized checklist. Learners evaluated fellows' teaching by using a structured evaluation tool; learner evaluations and the observer checklist formed the basis for written feedback. Changes in fellows' pedagogic knowledge, attitudes, and self-reported skills were analyzed by using Friedman and Wilcoxon rank-sum test at baseline, immediate postintervention, and 6-month follow-up.
Forty fellows participated. Fellows' self-ratings significantly improved from baseline to 6-month follow-up for development of learning objectives, effectively reinforcing performance, using teaching techniques to promote critical thinking, providing constructive feedback, and using case studies to teach general rules. Fellows significantly increased agreement with the statement "providing background and context is important" (4.12 to 4.44, P = .02).
Simulation was an effective means of educating fellows about teaching, with fellows' attitudes and self-rated confidence improving after participation but returning to baseline at the 6-month assessment. The simulation identified common weaknesses of fellows as teachers, including failure to provide objectives to learners, failure to provide a summary of key learning points, and lack of inclusion of all learners.
模拟是一种教授临床技能的有效方法，但尚未广泛应用于培训学员如何教学。
我们通过使用高保真模拟（带有生命体征的人体模型）评估了一项针对儿科住院医师的课程，以提高教学技能。
干预包括一场关于成人学习和主动学习技巧的讲座、根据住院医师的亚专业编写一个病例，以及向住院医师和医学生讲授该病例。一名教育工作者使用标准化清单对教学进行观察。学习者通过使用结构化评估工具对住院医师的教学进行评估；学习者评估和观察者清单构成了书面反馈的基础。在基线、干预后即刻和6个月随访时，使用弗里德曼检验和威尔科克森秩和检验分析住院医师教学知识、态度和自我报告技能的变化。
40名住院医师参与。从基线到6个月随访，住院医师在制定学习目标、有效强化表现、使用教学技巧促进批判性思维、提供建设性反馈以及使用案例研究教授一般规则方面的自我评分显著提高。住院医师对“提供背景和情境很重要”这一说法的认同度显著增加（从4.12提高到4.44，P = 0.02）。
模拟是培训住院医师教学的有效手段，住院医师参与后态度和自我评定的信心有所提高，但在6个月评估时又回到基线水平。模拟确定了住院医师作为教师的常见弱点，包括未向学习者提供目标、未对关键学习要点进行总结以及未涵盖所有学习者。
