Pascoe Jennifer M, Nixon James, Lang Valerie J
Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York.
J Hosp Med. 2015 Feb;10(2):125-30. doi: 10.1002/jhm.2302.
Hospitalist educators face a number of challenges in teaching clinical reasoning to residents and medical students. Helping to develop trainees' clinical acumen is an essential and highly nuanced process, yet complex patients, documentation requirements, and productivity goals compete with teaching time. Workplace-based assessment is particularly important for residents with the institution of the developmental milestones for meeting Accreditation Council for Graduate Medical Education competencies. Two frameworks for facilitating the clinical reasoning discussion-the One-Minute Preceptor preceptor and SNAPPS-have been well studied in the outpatient setting with positive results. Both models show promise for use in the inpatient teaching environment with little modification. This narrative review compares and contrasts these 2 teaching frameworks and discusses their application to the inpatient teaching environment. These models can provide opportunities for hospitalist educators to better assess trainees, integrate regular feedback, and encourage self-directed learning. These teaching frameworks can also allow hospitalists to provide more focused education to trainees without taking additional valuable time.
住院医师教育工作者在向住院医师和医学生传授临床推理时面临诸多挑战。帮助培养学员的临床敏锐度是一个至关重要且极为细致入微的过程,然而复杂的患者、文档要求以及工作效率目标都与教学时间相互竞争。基于工作场所的评估对于住院医师而言尤为重要,因为这涉及到为满足毕业后医学教育认证委员会能力要求而设立的发展里程碑。在门诊环境中,用于促进临床推理讨论的两个框架——一分钟带教模式和SNAPPS——已得到充分研究且取得了积极成果。这两种模式只需稍加修改就有望应用于住院教学环境。本叙述性综述对这两种教学框架进行了比较和对比,并讨论了它们在住院教学环境中的应用。这些模式能够为住院医师教育工作者提供机会,以便更好地评估学员、整合定期反馈并鼓励自主学习。这些教学框架还能使住院医师在不占用额外宝贵时间的情况下,为学员提供更有针对性的教育。