Diachun Laura, Charise Andrea, Goldszmidt Mark, Hui Yin, Lingard Lorelei
Department of Medicine, The University of Western Ontario, London, ON; ; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; ; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
Obermann Center for Advanced Studies, University of Iowa, University of Iowa, Iowa City, IA, USA;
Can Geriatr J. 2014 Dec 2;17(4):126-32. doi: 10.5770/cgj.17.133. eCollection 2014 Dec.
While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met "by random opportunity".((1)) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity.
Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings' case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings' teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital.
The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met.
More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity.
虽然主要的临床实习模块可能有与老年医学、同性恋、双性恋、跨性别者健康以及姑息治疗等专业领域相关的目标，但有人担心教学活动可能没有充分关注这些目标。相反，这些目标被认为是“通过随机机会”实现的。（(1)）本研究探讨了内科临床教学单元中老年医学学习机会的情况，以更好地理解通过随机机会设置课程的可行性和局限性。
我们使用了对13名65岁以上患者的晨间病例讨论录音以及加拿大医学生老年医学核心能力标准，对每个病例中潜在的老年医学和非老年医学学习机会进行了内容分析。将这些学习机会与主治医生的病例讨论教学进行了比较。这13个病例包含40个与老年医学相关的问题和110个与非老年医学相关的问题。虽然许多老年医学问题（如谵妄、跌倒）与当前疾病直接相关，但主治医生的教学讨论几乎完全集中在非老年医学问题上，如糖尿病和贫血的管理，其中许多问题与住院原因的直接相关性较小。
作者发现，普通内科轮转提供了获得老年医学能力的机会。然而，本研究中这些机会的罕见利用表明，在通过随机机会设置的课程中，有机会并不意味着就可以假定学习目标会实现。
需要更多研究来调查这些发现是否可推广到其他弱势群体，本科生预期通过随机机会设置的课程来了解这些群体。
Zotero 插件