跨显性、隐性和课外学习：对三个儿科住院医师培训项目中住院医师在临床领域感知到的学习相对比例的探索性研究。

Learning across the explicit, implicit, and extra-curricula: an exploratory study of the relative proportions of residents' perceived learning in clinical areas at three pediatric residency programs.

作者信息

Balmer Dorene F, Quiah Samuel, DiPace Jennifer, Paik Steve, Ward Mark A, Richards Boyd F

机构信息

D.F. Balmer is associate director, Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital, and associate professor of pediatrics, Baylor College of Medicine, Houston, Texas. S. Quiah is education, assessment, and evaluation specialist, Center for Education Research and Evaluation, Columbia University Medical Center, New York, New York. J. DiPace is assistant professor of pediatrics, Weill Cornell Medical College, New York, New York. S. Paik is assistant professor of pediatrics, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, New York. M.A. Ward is associate professor of pediatrics, Baylor College of Medicine, Houston, Texas. B.F. Richards is assistant vice president, Columbia University College of Physicians and Surgeons, director, Center for Education Research and Evaluation, and professor of medical education in pediatrics, Columbia University Medical Center, New York, New York.

出版信息

Acad Med. 2015 Nov;90(11):1547-52. doi: 10.1097/ACM.0000000000000755.

DOI:10.1097/ACM.0000000000000755

PMID:25993281

Abstract

PURPOSE

This exploratory multisite study investigated relative proportions of residents' perceived learning across the explicit, implicit (typically called hidden or informal), and extra-curricula for six Clinical Learning Environment Review (CLER) focus areas-patient safety, health care quality, care transitions, supervision, fatigue management, and professionalism-using qualitative and numeric data.

METHOD

In April through June 2013, the authors recruited and interviewed third-year categorical pediatric residents from three sites. For each CLER focus area, the authors asked residents to think aloud while they assigned a total of 60 points to the explicit, implicit, and extra-curricula, according to where they perceived their learning occurred. All interviews were audio taped and transcribed verbatim. The authors coded qualitative data from interviews using the constant comparative method, scrutinized qualitative data for themes, and reviewed qualitative and numeric data.

RESULTS

A total of 28/79 (35%) residents participated. Residents perceived learning to occur most often in the implicit curriculum for five of the six CLER focus areas; the one exception being health care quality, which predominantly took place in the explicit curriculum. In the implicit curriculum, role modeling and "learning by doing" were frequently reported modes of learning. The explicit curriculum was perceived as an important baseline for understanding clinical areas. Relatively less learning was perceived to occur in the extra-curriculum.

CONCLUSIONS

The authors believe that recognizing learning in "other-than-explicit" curricula could broaden the medical education community's understanding of the purview of the medical education curriculum and help educators tap into underused educational opportunities for important clinical topics.

摘要

目的

这项探索性多中心研究使用定性和定量数据，调查了六个临床学习环境审查（CLER）重点领域（患者安全、医疗质量、护理过渡、监督、疲劳管理和职业素养）中，住院医师在显性、隐性（通常称为隐藏或非正式）和课外学习方面的相对比例。

方法

2013年4月至6月，作者招募并采访了来自三个地点的三年级儿科住院医师。对于每个CLER重点领域，作者要求住院医师在根据他们认为学习发生的地方，将总共60分分配给显性、隐性和课外学习时，边思考边说。所有访谈都进行了录音并逐字转录。作者使用持续比较法对访谈中的定性数据进行编码，仔细审查定性数据中的主题，并审查定性和定量数据。