Veinot Paula, Lin William, Woods Nicole, Ng Stella
Centre for Ambulatory Care Education, Women's College Hospital, University of Toronto, Ontario, Canada.
The Wilson Centre, University of Toronto, Ontario, Canada.
Can Med Educ J. 2017 Jun 30;8(3):e37-e48. eCollection 2017 Jun.
Ambulatory care (AC) experiences within medical education are garnering increasing attention. We sought to understand how faculty and residents' describe their experiences of AC and ambulatory care education (ACEduc) within, between, and across disciplinary contexts.
We designed a Stakian collective case study, applying constructivist grounded theory analytic methods. Using purposive and snowball sampling, we interviewed 17 faculty and residents across three instrumental cases: family medicine, psychiatry, surgery. Through constant comparative analysis, we identified patterns within, between, and across cases.
Family medicine and psychiatry saw AC as an inherent part of continuous, longitudinal care; surgery equated AC with episodic experiences in clinic, differentiating it from operating. Across cases, faculty and residents cautiously valued ACEduc, and in particular, considered it important to develop non-medical expert competencies (e.g., communication). However, surgery residents described AC and ACEduc as less interesting and a lower priority than operating. Educational structures mediated these views.
Differences between cases highlight a need for further study, as universal assumptions about ACEduc's purposes and approaches may need to be tempered by situated, contextually-rich perspectives. How disciplinary culture, program structure, and systemic structure influence ACEduc warrant further consideration as does the educational potential for explicitly framing learners' perspectives.
医学教育中的门诊护理（AC）体验正受到越来越多的关注。我们试图了解教师和住院医师如何描述他们在学科背景内、之间以及跨学科背景下的AC和门诊护理教育（AC教育）体验。
我们设计了一项斯塔克式集体案例研究，应用建构主义扎根理论分析方法。采用目的抽样和滚雪球抽样，我们对来自家庭医学、精神病学、外科学这三个工具性案例的17名教师和住院医师进行了访谈。通过持续比较分析，我们确定了案例内、案例间以及跨案例间的模式。
家庭医学和精神病学将AC视为持续纵向护理的固有组成部分；外科学将AC等同于临床中的偶发经历，将其与手术区分开来。在所有案例中，教师和住院医师谨慎地重视AC教育，尤其认为培养非医学专家能力（如沟通能力）很重要。然而，外科住院医师认为AC和AC教育不如手术有趣，优先级也更低。教育结构调节了这些观点。
案例间的差异凸显了进一步研究的必要性，因为关于AC教育目的和方法的普遍假设可能需要根据具体的、情境丰富的观点进行调整。学科文化、项目结构和系统结构如何影响AC教育值得进一步考虑，明确构建学习者观点的教育潜力也值得考虑。
