Dr. Han is assistant professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Roberts is associate professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Korte is assistant professor, Organization Learning, Performance, and Change, School of Education, Colorado State University, Fort Collins, Colorado.
Acad Med. 2015 Feb;90(2):231-9. doi: 10.1097/ACM.0000000000000544.
To understand medical students' learning experiences in clerkships: learning expectations (what they expect to learn), learning process (how they learn), and learning outcomes (what they learn).
Using a longitudinal qualitative research design, the authors followed the experiences of 12 participants across their clerkship year (2011-2012) at the Southern Illinois University School of Medicine. Interview data from each participant were collected at three points (preclerkship, midclerkship, and postclerkship) and analyzed using a grounded theory approach. Additionally, the authors observed participants through a full clerkship day to augment the interviews.
Before clerkships, students expected to have more hands-on experiences and become more knowledgeable by translating textbook knowledge to real patients and practicing diagnostic thinking. During clerkships, students experienced ambiguity and subjectivity of attending physicians' expectations and evaluation criteria. They perceived that impression management was important to ensure that they received learning opportunities and good evaluations. After clerkships, students perceived that their confidence increased in navigating the health care environments and interacting with patients, attendings, and residents. However, they felt that there were limited opportunities to practice diagnostic thinking. Students could not clearly discern the decision-making processes used by attending physicians. Although they saw many patients, they perceived that their learning was at the surface level.
Students' experiential learning in clerkships occurred through impression management as a function of dynamic social and reciprocal relationships between students and attendings or residents. Students reported that they did not learn comprehensive clinical reasoning skills to the degree they expected in clerkships.
了解医学生在实习期间的学习经历：学习期望（他们期望学习什么）、学习过程（他们如何学习）和学习成果（他们学到了什么）。
采用纵向定性研究设计，作者在 2011 年至 2012 年期间，跟随 12 名参与者在南伊利诺伊大学医学院实习期间的经历。从每位参与者收集三次（实习前、实习中和实习后）的访谈数据，并使用扎根理论方法进行分析。此外，作者通过完整的实习日观察参与者，以补充访谈。
在实习前，学生们期望通过将课本知识应用于真实患者并实践诊断思维，获得更多的实践经验并增加知识储备。在实习期间，学生们经历了主治医生期望和评估标准的模糊性和主观性。他们认为印象管理对于确保获得学习机会和获得良好评价很重要。实习后，学生们认为他们在导航医疗保健环境和与患者、主治医生和住院医生互动方面的信心有所增强。然而，他们认为练习诊断思维的机会有限。学生们无法清楚地分辨主治医生使用的决策过程。尽管他们看了很多病人，但他们认为自己的学习只是表面的。
学生在实习中的体验式学习是通过印象管理来实现的，这是学生和主治医生或住院医生之间动态的社会和互惠关系的功能。学生们报告说，他们在实习中没有像预期的那样全面地学习临床推理技能。
