Meral Savran Mona, Tranum-Jensen Jørgen, Frost Clementsen Paul, Hastrup Svendsen Jesper, Holst Pedersen Jesper, Seier Poulsen Steen, Arendrup Henrik, Konge Lars
Center for Clinical Education, Center for HR, the Capital Region of Denmark, Copenhagen, Denmark.
Institute of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.
Clin Anat. 2015 Jul;28(5):568-75. doi: 10.1002/ca.22557. Epub 2015 May 14.
Reasoning in a clinical context is an attribute of medical expertise. Clinical reasoning in medical school can be encouraged by teaching basic science with a clinical emphasis. The aim of this study was to investigate whether anatomy is being taught in a way that facilitates the development of clinical reasoning. Two multiple-choice tests on thoracic anatomy were developed using a modified Delphi approach with groups of four clinical consultants and four teachers, respectively, expressing their opinions about knowledge relevant to thoracic anatomy. Validity was assessed by administering the tests to clinical consultants, anatomy teachers, and pre-course medical students. Post-course medical students took both tests to explore the focus of the course, i.e., whether it facilitated clinical reasoning. The pre-course students scored significantly lower than the teachers and post-course students on both tests and lower than the consultants on the consultants' test (P < 0.001 for all comparisons). The teachers significantly outperformed the consultants (P = 0.03 on the consultants' test, P < 0.001 on the teachers' test) and the medical students (P < 0.001 on both tests). The post-course students scored significantly lower on the consultants' test (P = 0.001) and significantly higher on the teachers' test (P = 0.02) than the consultants. This study demonstrates poor performances by medical students on a test containing clinically relevant anatomy, implying that the teaching they have received has not encouraged clinical reasoning.
临床情境中的推理是医学专业素养的一项特质。在医学院校中，可以通过以临床为重点教授基础科学来促进临床推理。本研究的目的是调查解剖学的教学方式是否有助于临床推理能力的发展。采用改良的德尔菲法，分别由四名临床顾问和四名教师组成的小组对与胸部解剖学相关的知识发表意见，据此编制了两份关于胸部解剖学的多项选择题测试。通过对临床顾问、解剖学教师和课程开始前的医学生进行测试来评估效度。课程结束后的医学生参加这两项测试以探究课程重点，即其是否促进了临床推理。在两项测试中，课程开始前的学生得分均显著低于教师和课程结束后的学生，在临床顾问的测试中得分低于临床顾问（所有比较的P值均<0.001）。教师的表现显著优于临床顾问（在临床顾问的测试中P = 0.03，在教师的测试中P < 0.001）和医学生（在两项测试中P均< 0.001）。课程结束后的学生在临床顾问的测试中得分显著低于临床顾问（P = 0.001），而在教师的测试中得分显著高于临床顾问（P = 0.02）。这项研究表明医学生在包含临床相关解剖学知识的测试中表现不佳，这意味着他们所接受的教学未能促进临床推理。
