Goldie J, Dowie A, Goldie Anne, Cotton Phil, Morrison Jill
Glasgow University Medical School , UK .
Med Teach. 2015 Feb;37(2):189-95. doi: 10.3109/0142159X.2014.947943. Epub 2014 Aug 26.
Learning in clinical settings is a function of activity, context and culture. Glasgow University's Medical School has undergone significant curricular change in recent years. This has coincided with change to National Health Service consultants' contracts, the introduction of the European Working Time Directive and the Modernising Medical Careers training initiative. We wished to explore teachers' and students' perspectives on the effects of change on our clinical teachers' capacity for teaching and on medical culture.
A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data were analysed using a "framework" technique.
Curricular change has led to shorter clinical attachments in the senior clinical rotation, which combined with more centralised teaching have had adverse effects on both formal and informal teaching during attachments. Consultants' NHS contract changes the implementation of the European Working Time Directive and changes to postgraduate training have adversely affected consultants' teaching capacity, which has had a detrimental effect on their relationships with students. Medical culture has also changed as a result of these and other societal influences.
The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.
在临床环境中的学习是活动、背景和文化的函数。格拉斯哥大学医学院近年来经历了重大的课程变革。这与国民保健制度顾问合同的变更、欧洲工作时间指令的引入以及医学职业现代化培训倡议同时发生。我们希望探讨教师和学生对变革对临床教师教学能力和医学文化的影响的看法。
采用定性方法，对教育督导进行个别访谈，并与高年级临床学生进行焦点小组讨论。使用“框架”技术对数据进行分析。
课程变革导致高年级临床轮转中的临床实习时间缩短，再加上教学更加集中，对实习期间的正式和非正式教学都产生了不利影响。顾问的国民保健制度合同变更、欧洲工作时间指令的实施以及研究生培训的变化对顾问的教学能力产生了不利影响，进而对他们与学生的关系产生了有害影响。由于这些以及其他社会影响，医学文化也发生了变化。
学徒模式在临床环境中仍被认为是相关的。这必须与系统教学的需求相平衡。结构和制度变革会影响学习。教师需要了解其所在机构的社会历史背景。
