拓宽医学生向初级保健的临床范围：一般实践中实施纵向实习的效果的前后分析。

Broadening the clinical spectrum for medical students towards primary care: a pre-post analysis of the effect of the implementation of a longitudinal clerkship in general practice.

机构信息

Institute of Primary Health Care Bern (BIHAM), University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland.

出版信息

BMC Med Educ. 2018 Mar 14;18(1):34. doi: 10.1186/s12909-018-1152-z.

DOI:10.1186/s12909-018-1152-z

PMID:29540163

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5853096/

Abstract

BACKGROUND

Exposure to a broad spectrum of patient cases is a mainstay of undergraduate medical education. This study aimed to assess how many primary care-specific clinical pictures final-year medical students in traditional block rotations had encountered, and how this changed after a curricular change that included the implementation of a four-year longitudinal clerkship in primary care.

METHODS

Final-year students before, and after, implementation of the clerkship were asked which of the clinical pictures most relevant to primary care they had seen. We compared the overall proportions of clinical pictures seen by the two cohorts.

RESULTS

In the first cohort, 96 (66%) students responded, and 94 (65%) in the second. Before the curricular change, students had encountered a mean of 26.3 of the 34 primary care-specific clinical pictures (77.2%). After implementation of the longitudinal clerkship, this increased by 1.1 (4.2%, P = 0.038). Among the eight clinical pictures seen the least by students in the first cohort, we found a significant increase in the proportion of students seeing polymalgia rheumatica, frozen shoulder, epicondylitis and Dupuytren's contracture after the clerkship's implementation.

CONCLUSION

The undergraduate longitudinal clerkship in primary care broadened the spectrum of clinical pictures seen by medical students, to include more clinical pictures commonly seen in primary care.

摘要

背景

接触广泛的患者病例是本科医学教育的基础。本研究旨在评估传统块状实习中，最后一年的医学生接触了多少种初级保健特有的临床图片，以及在包括实施为期四年的初级保健纵向实习在内的课程改革后，这种情况发生了怎样的变化。

方法

在实施实习前后，要求最后一年的学生回答哪些与初级保健最相关的临床图片是他们见过的。我们比较了两组学生看到的临床图片的总体比例。

结果

在第一组中，有 96 名（66%）学生做出了回应，第二组中有 94 名（65%）学生做出了回应。在课程改革之前，学生平均遇到了 34 种初级保健特有的临床图片中的 26.3 种（77.2%）。在实施纵向实习后，这一比例增加了 1.1 种（4.2%，P=0.038）。在第一组学生看到最少的 8 种临床图片中，我们发现，在实习后，学生看到风湿性多肌痛、冻结肩、肱骨外上髁炎和掌腱膜挛缩的比例显著增加。