O'Neill Lotte Dyhrberg, Morcke Anne Mette, Eika Berit
Centre for Health Sciences Education, INCUBA Science Park Skejby, Aarhus University, Palle Juul-Jensens Boulevard 82, building B, 8200, Århus N, Denmark.
Rector's Office, Aarhus University, Aarhus, Denmark.
Adv Health Sci Educ Theory Pract. 2016 Dec;21(5):1061-1079. doi: 10.1007/s10459-016-9677-6. Epub 2016 Mar 29.
Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.
研究文献中普遍建议在医学教育中尽早识别并支持学习困难的学生，尽管目前几乎没有证据表明医学教育中教师早期判断的诊断质量如何。本研究的目的是检验基于教师对课堂行为的非正式判断对医学院校学习困难进行早期诊断的有效性。研究设计为前瞻性队列研究，结果/真实标准为解剖学课程不及格和从医学院辍学。在解剖学课程开始六周后，学生助教根据他们在大班教学环境中与学生的日常接触，试图识别那些他们认为会在解剖学课程中不及格或辍学的医学生。此外，他们还被要求描述所观察到的学习困难的指标。16名学生助教对429名医学生进行了学习困难迹象的评估。到第六周时，学生助教能够识别出最终不及格或辍学学生中的约四分之一至三分之一，并且对于他们所识别出的四分之三的学习困难学生，他们的判断是正确的。在控制了之前考试成绩的情况下，学生助教的非正式判断对这两个结果均显示出递增效度。缺乏参与度、缺乏投入、学业成绩差、社交互动不良以及普遍的苦恼迹象是所识别出的学习困难的主要指标。教师对课堂行为的非正式判断可能是早期识别学习困难医学生的一个尚未开发的信息来源，其价值超过正式测试。
