Ackerman Sara L, Boscardin Christy, Karliner Leah, Handley Margaret A, Cheng Sarah, Gaither Thomas W, Hagey Jill, Hennein Lauren, Malik Faizan, Shaw Brian, Trinidad Norver, Zahner Greg, Gonzales Ralph
a Department of Social and Behavioral Sciences , University of California, San Francisco , San Francisco , California , USA.
b Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
Teach Learn Med. 2016;28(2):183-91. doi: 10.1080/10401334.2016.1146606.
Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools' curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education.
A multidisciplinary clinician and nonclinician faculty team partnered with a cardiology outpatient clinic to design a 9-month clerkship for 1st-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013-2014, 8 trainees participated in educational seminars, research activities, and 9-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students' detailed field notes.
The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the United States. All educational activities took place at the university's medical school and at the medical center's cardiology outpatient clinic.
Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients' experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented.
The Action Research Program is a small pilot project that demonstrates an innovative pairing of experiential and didactic training in systems-based practice. Lessons learned include the need for dedicated time and faculty support for students' improvement projects, which were the least successful aspect of the program. We recommend that future projects aiming to combine clinical training and quality improvement projects designate distinct blocks of time for trainees to pursue each of these activities independently. In 2014-2015, the University of California, San Francisco School of Medicine incorporated key features of the Action Research Program into the standard curriculum, with plans to build upon this foundation in future curricular innovations.
基于系统的实践关注医疗服务的组织、融资和提供。美国医学院协会建议将基于系统的实践纳入医学院课程。然而，基于系统的实践中的体验式学习，包括提高临床护理质量和效率的实用策略，在医学教育中往往缺失或纳入情况不一。
一个多学科的临床医生和非临床医生教师团队与一家心脏病门诊诊所合作，为一年级医学生设计了一个为期9个月的见习项目，重点是基于系统的实践、临床护理的提供以及提高临床运营质量和效率的策略。该见习项目称为行动研究计划。在2013 - 2014年，8名学员参加了教育研讨会、研究活动以及为期9周的诊所轮转。定性的过程和结果评估采用了对学生、诊所工作人员和指导医生的访谈，以及学生的详细实地记录。
行动研究计划是在美国旧金山加利福尼亚大学（一所学术医疗中心）制定并实施的。所有教育活动都在该大学的医学院和医疗中心的心脏病门诊诊所进行。
学生报告并展示了对护理提供系统如何运作的理解有所增加、临床技能得到提高、与患者互动的信心增强以及对患者体验的理解加深。临床医生报告称，由于他们对学生前所未有的指导作用，诊所层面的效率有所提高，医疗助理的工作表现和工作满意度也有所改善。一些临床医生在学生跟班并在与患者互动时提问时感到负担过重。大多数由学生主导的改进项目并未完全实施。
行动研究计划是一个小型试点项目，展示了基于系统的实践中体验式培训和讲授式培训的创新结合。吸取的经验教训包括需要为学生的改进项目提供专门时间和教师支持，而这是该项目最不成功的方面。我们建议，未来旨在将临床培训和质量改进项目相结合的项目，应为学员指定不同的时间段，让他们分别独立开展这些活动。2014 - 2015年，旧金山加利福尼亚大学医学院将行动研究计划的关键特征纳入标准课程，并计划在未来的课程创新中以此为基础进一步发展。
