D.L. Klamen is associate dean for education and curriculum, and professor and chair, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois.
Acad Med. 2015 Oct;90(10):1314-7. doi: 10.1097/ACM.0000000000000733.
There are many calls in the literature for changes in how medical students are educated. Although many curricular innovations have been attempted, a look at the theory behind how complex skills are learned provides useful information to guide new curriculum developments. The requirement of deliberate practice as the road map for success in the learning of clinical skills suggests that perhaps the current clinical milieu is not an optimal place for medical students to learn. The idiosyncrasy inherent in the dramatically changed medical landscape of the last 20 years makes it difficult for such practice to occur; the apprentice model of legitimate peripheral participation in a community of practice as it used to exist does no longer. Indeed, current workplace environments are at odds with the needs of medical students. Overwhelming numbers of goals and objectives in existing third-year clerkships serve as wish lists of what students should learn. They should be replaced by a systematic, longitudinal curriculum in which all students can be guaranteed to have encountered the core clinical competencies as defined. Moving the goals and objectives of the current clerkships to a longitudinal, spiral curricular format frees up clinical time in the third year to be used for students to find their future specialty and socialize into medicine. Doing so allows for an opportunity for students to spend extended time in areas of their interest. Moving to such a new curriculum format maximizes and optimizes learning while embracing the reality of current clinical workplace environments.
文献中有许多呼吁要求改变医学生的教育方式。尽管已经尝试了许多课程创新，但从学习复杂技能的理论背后可以看出，一些有用的信息可以为新的课程发展提供指导。刻意练习是学习临床技能成功的路线图这一要求表明，目前的临床环境可能不是医学生学习的最佳场所。过去 20 年来，医学领域发生了巨大变化，这种变化具有特殊性，使得这种实践变得困难；曾经存在的实践社区中合法边缘参与的学徒模式已经不复存在。事实上，目前的工作场所环境与医学生的需求不符。现有的三年级实习中过多的目标和目的只是学生应该学习的内容的愿望清单。它们应该被一个系统的、纵向的课程所取代，在这个课程中，所有学生都可以保证接触到定义的核心临床能力。将当前实习的目标和目的转移到纵向、螺旋式课程模式中，可以为学生找到未来的专业方向并融入医学领域腾出临床时间。这样做可以让学生有机会在自己感兴趣的领域花费更多的时间。采用这种新的课程模式可以最大限度地提高学习效果，同时也能接受当前临床工作环境的现实。
