Steinert Yvonne, Basi Mandeep, Nugus Peter
a Centre for Medical Education , McGill University , Montreal , Quebec , Canada.
Med Teach. 2017 Dec;39(12):1238-1244. doi: 10.1080/0142159X.2017.1360473. Epub 2017 Aug 22.
Clinical teaching lies at the heart of medical education. However, few studies have explored the embedded nature of teaching and clinical care. The goal of this study was to examine the process of clinical teaching as it naturally, and spontaneously, unfolds in a broad range of authentic contexts with medical students and residents.
This focused ethnographic study consisted of 160 hours of participant observation and field interviews with three internal medicine teams. Thematic analysis guided data organization and interpretation.
Three overlapping themes emerged: the interconnectedness between clinical work and pedagogy; a multiplicity of teachers; and the influence of space and artifacts on teaching and learning. Clinical teaching, which was deeply embedded in clinical care, was influenced by the acuity of patient problems, learner needs, and the context in which teaching unfolded; it also occurred on a spectrum that included planned, opportunistic, formal, and informal teaching (and learning).
Study findings suggest that clinical teaching, which is marked by an intersection between service and teaching, can be viewed as an example of work-based teaching. They also yield suggestions for the enhancement of clinical teaching in inpatient settings, faculty development, and educational policies that recognize clinical teaching and learning.
临床教学是医学教育的核心。然而，很少有研究探讨教学与临床护理的内在联系。本研究的目的是考察临床教学在与医学生和住院医师广泛的真实情境中自然、自发展开的过程。
这项重点人种学研究包括对三个内科团队进行160小时的参与观察和现场访谈。主题分析指导数据的组织和解释。
出现了三个相互重叠的主题：临床工作与教学法之间的相互联系；教师的多样性；空间和物品对教学与学习的影响。深深嵌入临床护理中的临床教学受到患者问题的严重程度、学习者需求以及教学展开的背景的影响；它也发生在一个包括计划、机会主义、正式和非正式教学（与学习）的范围内。
研究结果表明，以服务与教学的交叉为特征的临床教学可被视为基于工作的教学的一个例子。它们还为改善住院环境中的临床教学、教师发展以及认可临床教学与学习的教育政策提出了建议。
