Yang Ying-Ying, Wang Shuu-Jiun, Yang Ling-Yu, Lirng Jiing-Feng, Huang Chia-Chang, Liang Jen-Feng, Lee Fa-Yauh, Hwang Shinn-Jang, Huang Chin-Chou, Kirby Ralph
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan.
BMJ Open. 2017 Sep 25;7(9):e016294. doi: 10.1136/bmjopen-2017-016294.
The primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness.
This comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ).
SETTING/PARTICIPANTS: 128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25).
For overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in 'confidence/coping' and 'SDL' domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in 'confidence/coping' and 'SDL' domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores.
Our study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk's HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.
初级医疗保健中心（PHCC）是医学生首次接触患者的场所。通常，医学生因缺乏在校病史采集（HT）、体格检查（PE）和自主学习（SDL）的适当技能培训，难以做好在PHCC及医院接触患者的准备，常感到沮丧。对于见习前的学生，本研究旨在比较PHCC培训以及PHCC培训与在校HT和PE培训模块相结合（PHCC+在校培训）对他们见习准备情况的效果。
本比较研究采用前瞻性、连续性、见习前组客观结构化临床考试（GOSCE）结束时、见习开始时的OSCE以及自我管理的医院实习准备问卷（PHPQ）。
设置/参与者：128名临床前见习志愿者（每年64名），接受PHCC培训（2014学年，除7周基于任务的小组学习外，还有7周PHCC培训，为对照组）以及PHCC培训与在校模块培训相结合（2015学年，除7周在校课程外，还有7周PHCC培训），在模块开始前（第1周）、模块结束时（第14周）和见习开始时（第25周）依次进行评估。
对于整体HT和PE技能，接受PHCC培训以及PHCC+在校模块培训的见习前学生在OSCE中的表现均优于GOSCE。此外，这种提高伴随着在“信心/应对”和“SDL”领域自我报告的PHPQ分数更高。在见习前阶段结束和见习开始阶段，PHCC+在校培训组在“信心/应对”和“SDL”领域的准备情况改善程度高于PHCC组。在PHCC+在校模块参与者中，观察到较高的平均PHPQ-SDL分数与较高的OSCE分数之间存在正相关。
我们的研究表明，由教师主导并由预先培训的二元学生辅助的PHCC+在校模块，在培养临床前见习学生的HT和PE技能以及强化SDL/患者管理能力以准备见习期医院实习方面是有效的。
