Asgarova Sevinj, MacKenzie Mark, Bates Joanna
S. Asgarova is a doctoral candidate, School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada. M. MacKenzie is clinical associate professor, Department of Family Practice, Faculty of Medicine, British Columbia, Vancouver, British Columbia, Canada. J. Bates is professor, Department of Family Practice, and scientist, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Acad Med. 2017 Nov;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S55-S60. doi: 10.1097/ACM.0000000000001911.
Patient continuity, described as the student participating in the provision of comprehensive care of patients over time, may offer particular opportunities for student learning. The aim of this study was to describe how students experience patient continuity and what they learn from it.
An interpretive phenomenological study was conducted between 2015 and 2016. Seventeen fourth-year medical students were interviewed following a longitudinal clinical placement and asked to describe their experiences of patient continuity and what they learned from each experience. Transcripts were analyzed by iteratively refining and testing codes, using health system definitions of patient continuity as sensitizing concepts to develop descriptive themes.
Students described three different forms of patient continuity. Continuity of care, or relational continuity, enabled students to build trusting and professional relationships with their patients. Geographical continuity allowed students to access information about patients from electronic records and their preceptors which allowed students to achieve diagnostic closure and learn to reevaluate their decisions. Students valued the learning that accrued from following challenging patients and addressing challenging decisions over time. Although difficult, these patient continuity experiences led students to critical reflection that was both iterative and deep, leading to intentions for future behavior.
Patient continuity in medical education does not depend solely on face-to-face continuity. Within various patient continuity experiences, following challenging patients and experiencing unanticipated diagnostic and management outcomes trigger critical reflection in students, leading to deep learning.
患者连续性是指学生随着时间推移参与对患者的全面护理，这可能为学生学习提供特殊机会。本研究的目的是描述学生如何体验患者连续性以及他们从中学习到了什么。
在2015年至2016年期间进行了一项诠释现象学研究。17名四年级医学生在进行纵向临床实习后接受了访谈，被要求描述他们对患者连续性的体验以及从每次经历中学到了什么。通过反复提炼和测试编码来分析访谈记录，将患者连续性的卫生系统定义用作敏感概念以形成描述性主题。
学生描述了三种不同形式的患者连续性。护理连续性或关系连续性使学生能够与患者建立信任和专业关系。地理连续性使学生能够从电子记录和带教老师那里获取患者信息，从而使学生能够完成诊断并学会重新评估自己的决策。学生重视随着时间推移跟踪具有挑战性的患者并处理具有挑战性的决策所积累的学习。尽管困难，但这些患者连续性经历促使学生进行反复且深入的批判性反思，从而形成对未来行为的意向。
医学教育中的患者连续性并不完全取决于面对面的连续性。在各种患者连续性经历中，跟踪具有挑战性的患者并经历意外的诊断和管理结果会引发学生的批判性反思，从而实现深度学习。
