Humm Karen R, May Stephen A
The Queen Mother Hospital for Animals, The Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA UK.
LIVE Centre, The Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA UK.
J Vet Med Educ. 2018 Summer;45(2):156-162. doi: 10.3138/jvme.1016-153r. Epub 2017 Nov 3.
A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students.
开展了一项混合方法研究，以调查在一所大学的首诊兽医诊所中，学生和教师对临床推理（CR）技能教学的重要性认知和教学效果，因为此前尚无相关描述。在围诊讨论中，对访谈数据进行定性分析，探讨有效学习和CR理解中被认为重要的目标及因素，同时对带教老师思维促进量表（PTPS）和学生思维行为量表（LTBS）（评估临床医生鼓励和学生展现的CR水平）进行定量分析。访谈分析中出现的关于目标的主题包括培养数据采集能力的愿望以及改进数据处理和CR的需求。与有效学习相关的主题是积极的以学生为中心的学习环境和反馈。II型CR得到了较好的描述，但临床医生和学生对I型CR重要性的认识较差，在某些情况下，I型CR被认为不合适。尽管许多临床医生和学生表示希望培养学生的CR能力，但在所分析的互动中，几乎没有证据表明这一情况实际发生，PTPS和LTBS得分较低。对于是否进行了有效的CR教学也缺乏了解，这表现为LTBS与学生CR发展的互动得分之间缺乏相关性。需要对临床医生和学生进行关于I型CR在首诊实践中的价值的进一步培训，以及对临床医生进行如何最好地支持学生CR发展的教育。
