Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, New York.
Anat Sci Educ. 2018 Nov;11(6):605-612. doi: 10.1002/ase.1785. Epub 2018 Mar 30.
Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.
医学生在三年级实习期间,预计会在患者身上进行常见的操作,如缝合。然而,这些经历通常被医学生视为压力源,而不是学习的机会。这种压力的根源是在被要求观察或在患者身上进行操作之前,缺乏对常见操作的指导。第一次在有压力的环境中接触操作可能会导致医学生信心下降,并减少他们未来执行这些操作的频率。作者试图通过以下两种方法来改变这种模式:(1)在解剖实验室中向一年级医学生介绍缝合模块;(2)在他们进行三年级实习期间遇到患者时,衡量其对学生态度和行为的影响。作者发现,早期和长期接触缝合术与增加学生对缝合患者的信心有关。参与缝合模块与增加学生识别缝合器械的信心有关(P<0.001)和缝合患者(P=0.013)。进一步表明,它通过增加暴露于缝合模块的学生的缝合事件的执行,对他们的行为产生了积极的影响(P<0.001)。这项研究表明,在低压力环境中尽早并有足够的机会练习程序性技能,可以提高学生在与患者互动时的信心,并改变学生的行为。