Chandrasekar Hamsika, Gesundheit Neil, Nevins Andrew B, Pompei Peter, Bruce Janine, Merrell Sylvia Bereknyei
Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA.
Adv Med Educ Pract. 2018 Apr 12;9:249-257. doi: 10.2147/AMEP.S155481. eCollection 2018.
It is a common educational practice for medical students to engage in case-based learning (CBL) exercises by working through clinical cases that have been developed by faculty. While such faculty-developed exercises have educational strengths, there are at least two major drawbacks to learning by this method: the number and diversity of cases is often limited; and students decrease their engagement with CBL cases as they grow accustomed to the teaching method. We sought to explore whether student case creation can address both of these limitations. We also compared student case creation to traditional clinical reasoning sessions in regard to tutorial group effectiveness, perceived gains in clinical reasoning, and quality of student-faculty interaction.
Ten first-year medical students participated in a feasibility study wherein they worked in small groups to develop their own patient case around a preassigned diagnosis. Faculty provided feedback on case quality afterwards. Students completed pre- and post-self-assessment surveys. Students and faculty also participated in separate focus groups to compare their case creation experience to traditional CBL sessions.
Students reported high levels of team engagement and peer learning, as well as increased ownership over case content and understanding of clinical reasoning nuances. However, students also reported decreases in student-faculty interaction and the use of visual aids ( < 0.05).
The results of our feasibility study suggest that student-generated cases can be a valuable adjunct to traditional clinical reasoning instruction by increasing content ownership, encouraging student-directed learning, and providing opportunities to explore clinical nuances. However, these gains may reduce student-faculty interaction. Future studies may be able to identify an improved model of faculty participation, the ideal timing for incorporation of this method in a medical curriculum, and a more rigorous assessment of the impact of student case creation on the development of clinical reasoning skills.
让医学生通过处理教师编写的临床病例来进行基于案例的学习（CBL）练习是一种常见的教学实践。虽然这种由教师编写的练习具有教育优势，但通过这种方法学习至少有两个主要缺点：病例的数量和多样性往往有限；随着学生逐渐习惯这种教学方法，他们对CBL病例的参与度会降低。我们试图探讨学生编写病例是否可以解决这两个局限性。我们还将学生编写病例与传统临床推理课程在辅导小组效果、临床推理方面的感知收获以及师生互动质量方面进行了比较。
十名一年级医学生参与了一项可行性研究，他们以小组形式围绕预先指定的诊断编写自己的患者病例。之后教师对病例质量提供反馈。学生完成自我评估前测和后测调查。学生和教师还分别参加了焦点小组，以将他们的病例编写经历与传统CBL课程进行比较。
学生报告了高水平的团队参与度和同伴学习，以及对病例内容的自主权增加和对临床推理细微差别理解的增强。然而，学生也报告了师生互动和视觉辅助工具使用的减少（<0.05）。
我们可行性研究的结果表明，学生编写的病例可以通过增加内容自主权、鼓励以学生为导向的学习以及提供探索临床细微差别的机会，成为传统临床推理教学的有价值补充。然而，这些收获可能会减少师生互动。未来的研究或许能够确定一种改进的教师参与模式、将这种方法纳入医学课程的理想时机，以及对学生编写病例对临床推理技能发展影响的更严格评估。
