Szyld Demian, Uquillas Kristen, Green Brad R, Yavner Steven D, Song Hyuksoon, Nick Michael W, Ng Grace M, Pusic Martin V, Riles Thomas S, Kalet Adina
From the Department of Emergency Medicine (D.S.), Brigham and Women's Hospital; The Center for Medical Simulation (D.S.), Boston, MA; New York Simulation Center for the Health Sciences (G.N., T.S.R., A.K.), New York; Institute for Innovations in Medical Education (M.V.P., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Obstetrics and Gynecology (K.U.), University of Southern California, Los Angeles, CA; Department of Emergency Medicine (B.R.G.), The Ohio State University, Cleveland, OH; Program for Medical Education and Technology (M.W.N., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Journalism (S.D.Y.), Central Connecticut State University; Department of Education (H.S.), Georgian Court University, Lakewood, NJ; Department of Surgery (T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Medicine (A.K.), Division of General Internal Medicine, Research on Medical Education Outcomes (ROMEO) Unit, and Program for Medical Education Innovation and Research (PrMEIR) (A.K.), NYU School of Medicine, New York, NY.
Simul Healthc. 2017 Dec;12(6):385-392. doi: 10.1097/SIH.0000000000000254.
"Transitions to residency" programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module.
Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55-0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47-0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37-0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students' patient encounter note (ICC, 0.55-0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board -approved study.
Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen's d, 0.30-1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen's d, -0.93; P = 0.000).
A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
“向住院医师过渡”项目旨在在医学生成为住院医师的过程中，最大限度地提高患者护理的质量和安全性。然而，最佳的教学或准备情况评估方法尚未确立。我们试图研究一种基于屏幕的交互式课程（WISE OnCall）对实习生处理常见临床值班问题的影响，该课程旨在让实习生为处理常见临床值班问题做好准备，并假设在完成该模块后，实习生的表现会有所提高。
招募高年级医学生参与这项单组预研究/后研究。学生接听标准化护士（SN）的呼叫，评估一名少尿的标准化患者（SP），与一个45分钟的关于少尿评估和管理的WISE OnCall模块互动，然后评估另一名病因不同的少尿SP。标准化患者使用一份37项、基于行为锚定的临床技能检查表评估临床技能（组内相关系数[ICC]，0.55 - 0.81）。标准化护士使用一份基于文献的33项锚定检查表对护理质量、安全性以及协作和跨专业沟通进行评分（ICC，0.47 - 0.52）。标准化患者和SN对同一名学生表现的评分具有相关性（r，0.37 - 0.62；P < 0.01）。医生根据学生的患者诊疗记录评估临床推理质量（ICC，0.55 - 0.68），这些评分与SP和SN的评分不相关。我们比较了前后的临床技能表现和临床推理。52名医学生（31%）完成了这项经机构审查委员会批准的研究。
在完成在线模块后，由SP、SN以及诊疗记录衡量的表现均显示出改善，大多具有中等至较大的效应量（科恩d值范围，0.30 - 1.88；P < 0.05）。出乎意料的是，模块结束后，SP对专业性的评分更差（科恩d值，-0.93；P = 0.000）。
一项简短的基于计算机的教育干预显著提高了即将毕业的医学生为住院医师工作做好准备所需的临床技能。
