Strowd Roy E, Salas Rachel Marie E, Cruz Tiana E, Gamaldo Charlene E
From the Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD.
Neurology. 2016 Feb 16;86(7):684-91. doi: 10.1212/WNL.0000000000002255. Epub 2015 Dec 30.
To define medical student goals in the neurology clerkship and explore the association between goal setting and student performance, clerkship satisfaction, self-directed learning (SDL), and interest in neurology.
A 4-year prospective study of consecutive second- to fourth-year medical students rotating through a required 4-week neurology clerkship was conducted. A goal-generating cohort (first 2 years) was enrolled to describe the breadth of student-derived goals. A goal-evaluating cohort (second 2 years) was used to evaluate the frequency of goal achievement and assess associations with performance (e.g., National Board of Medical Examiners [NBME], examination), satisfaction, and SDL behaviors (both based on 5-point Likert scale).
Of 440 evaluable students, 201 were goal-generating and 239 goal-evaluating. The top 3 goals were (1) improvement in neurologic examination, (2) understanding neurologic disease, and (3) deriving a differential diagnosis. More than 90% (n = 216/239) of students reported achieving goals. Achievers reported significantly higher clerkship satisfaction (4.2 ± 0.8 vs. 2.8 ± 1.0, p < 0.0001), greater interest in neurology (71% vs. 35%, p = 0.001), and higher observed tendency toward SDL (4.5 ± 0.5 vs. 4.1 ± 0.8, p < 0.0001). After adjusting for age and training, NBME scores were 1.7 points higher in achievers (95% confidence interval 0.1-3.2, p = 0.04).
Students consistently generated similar goals for a required neurology clerkship. Goal achievers had better adjusted standardized test scores, higher satisfaction, and greater tendency toward SDL. This student-generated, goal-setting program may be particularly appealing to clinicians, educators, and researchers seeking resource-lean mechanisms to improve student experience and performance in the clinical clerkships.
明确医学生在神经科实习中的目标，并探讨目标设定与学生成绩、实习满意度、自主学习（SDL）以及对神经科的兴趣之间的关联。
对连续4年轮转为期4周神经科实习的二至四年级医学生进行了一项前瞻性研究。招募了一个目标生成队列（前两年）来描述学生提出的目标范围。使用一个目标评估队列（后两年）来评估目标达成的频率，并评估与成绩（如美国医学考试委员会[NBME]考试）、满意度和SDL行为（均基于5分李克特量表）之间的关联。
在440名可评估的学生中，201名属于目标生成队列，239名属于目标评估队列。前三大目标分别是：（1）神经科体格检查的改善，（2）对神经疾病的理解，（3）得出鉴别诊断。超过90%（n = 216/239）的学生报告实现了目标。目标达成者报告的实习满意度显著更高（4.2 ± 0.8 vs. 2.8 ± 1.0，p < 0.0001），对神经科的兴趣更大（71% vs. 35%，p = 0.001），并且观察到的自主学习倾向更高（4.5 ± 0.5 vs. 4.1 ± 0.8，p < 0.0001）。在对年龄和培训进行调整后，目标达成者的NBME分数高1.7分（95%置信区间0.1 - 3.2，p = 0.04）。
学生们在必修的神经科实习中始终提出了相似的目标。目标达成者有更好的标准化考试成绩调整、更高的满意度以及更强的自主学习倾向。这个由学生生成的目标设定项目可能对寻求资源精简机制以改善学生临床实习体验和表现的临床医生、教育工作者和研究人员特别有吸引力。
