提高实习准备：为实习前学生开设医院医学选修课。
Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students.
机构信息
a Division of Hospital Medicine , San Francisco VA Medical Center , San Francisco , CA , USA.
b Department of Medicine , University of California San Francisco , San Francisco , CA , USA.
出版信息
Med Educ Online. 2017;22(1):1307082. doi: 10.1080/10872981.2017.1307082.
BACKGROUND
Medical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships.
INTERVENTION
Our four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally 'non-teaching' service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills.
OUTCOME
In the elective's first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students' self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans.
CONCLUSIONS
Students found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students' perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource - the hospital medicine 'non-teaching' service - and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation.
ABBREVIATIONS
A&P: Assessment and plan; H&P: History and physical; ILP: Individual learning plan.
背景
医学生在实习期间经常难以应用他们新获得的临床技能。虽然过渡实习可以使学生适应新的角色和流程，但学生可能会受益于在课程早期就在住院环境中发展临床技能，以提高实习准备。
干预措施
我们的四到六节选修课程为预实习学生提供了在住院环境中进行个性化学习的机会，旨在提高实习准备。学生与教员一对一合作，教员通过指导、刻意练习和有针对性的反馈来促进个性化学习。第二年的医学生在退伍军人事务部（VA）医院的医院医学科只与主治医生一起工作，参加半天的课程。大多数学生在全班范围内发布广告后自愿选择参加该选修课程。该选修课程还接受因临床技能需要补救的学生。
结果
在选修课程的头两年，有 25 名学生参加，47 名学生候补。我们比较了选修学生和候补（非参与者）学生在他们的第一个实习期间在几个临床和专业领域的自我效能感。选修学生在体检、口头陈述、评估和计划制定方面报告的实习准备情况明显高于非参与者。
结论
学生发现与主治医生的一对一反馈和个性化关注是该课程特别有用的方面。这一经常被引用的好处表明学生感受到了他们的需求，以及他们对个性化反馈的重视。我们的创新利用了一个未开发的资源-医院医学“非教学”服务-并为有兴趣为所有学生（包括需要补救的学生）增强早期临床技能的学校提供了一种可行的选择。
缩写词
A&P：评估和计划；H&P：病史和体检；ILP：个人学习计划。
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