Department of Emergency and Hospital Medicine, Lehigh Valley Health Network.
Department of Education, Lehigh Valley Health Network, Allentown, Pennsylvania; Faculty at University of South Florida, Morsani College of Medicine, Tampa, Florida.
Clin Ther. 2018 Aug;40(8):1375-1383. doi: 10.1016/j.clinthera.2018.06.013. Epub 2018 Jul 29.
The quality of clinical teaching in the emergency department from the students' perspective has not been previously described in the literature. Our goals were to assess senior residents' teaching ability from the resident/teacher and student/learner viewpoints for any correlation, and to explore any gender association. The secondary goal was to evaluate the possible impact of gender on the resident/student dyad, an interaction that has previously been studied only in the faculty/student pairing.
After approval by an institutional review board, a 1-year, grant-funded, single-site, prospective study was implemented at a regional medical campus that sponsors a 4-year dually approved emergency medicine residency. The residency hosts both medical school students (MSs) and physician's assistant students (PAs). Each student and senior resident working concurrently completed a previously validated ER Scale, which measured residents' teaching performance in 4 categories: Didactic, Clinical, Approachable, and Helpful. Students evaluated residents' teaching, while residents self-assessed their performance. The participants' demographic characteristics gathered included prior knowledge of or exposure to clinical teaching models. Gender was self-reported by participants. The analysis accounted for multiple observations by comparing participants' mean scores.
Ninety-nine subjects were enrolled; none withdrew consent. Thirty-seven residents (11 women) and 62 students (39 women) from 25 MSs and 6 PA schools were enrolled, completing 517 teaching assessments. Students evaluated residents more favorably in all ER Scale categories than did residents on self-assessments (P < 0.0001). This difference was significant in all subgroup comparisons (types of school versus postgraduate years [PGYs]). Residents' evaluations by type of student (MS vs PA) did not show a significant difference. PGY 3 residents assessed themselves higher in all categories than did PGY 4 residents, with Approachability reaching significance (P = 0.0105). Male residents self-assessed their teaching consistently higher than did female residents, significantly so on Clinical (P = 0.0300). Students' evaluations of the residents' teaching skills by residents' gender did not reveal gender differences.
MS and PA students evaluated teaching by EM senior residents statistically significantly higher than did EM residents on self-evaluation when using the ER Scale. Students did not evaluate residents' teaching with any difference by gender, although male residents routinely self-assessed their teaching abilities more positively than did female residents. These findings suggest that, if residency programs utilize resident self-evaluation for programmatic evaluation, the gender of the resident may impact self-scoring. This cohort may inform future study of resident teaching in the emergency department, such as the design of future resident-as-teacher curricula.
急诊科临床教学的质量从学生的角度来看，在文献中尚未有过描述。我们的目标是评估高年级住院医师的教学能力，从住院医师/教师和学生/学习者的角度来看，这种能力是否存在任何相关性，并探讨任何与性别相关的问题。次要目标是评估性别对住院医师/学生对子的可能影响，这种相互作用以前仅在教职员工/学生配对中进行过研究。
在机构审查委员会批准后，在一个地区医疗校园内实施了为期 1 年、由赠款资助的、单站点、前瞻性研究，该校园赞助了一个为期 4 年的双重认可的急诊医学住院医师实习项目。该住院医师实习项目同时接待医学生（MS）和医师助理学生（PA）。每位学生和高年级住院医师同时完成了之前经过验证的 ER 量表，该量表从四个方面衡量住院医师的教学表现：教学、临床、可接近性和有益性。学生评估住院医师的教学，而住院医师自我评估其表现。参与者收集的人口统计学特征包括对临床教学模式的预先了解或接触。参与者通过自我报告来确定性别。分析考虑了通过比较参与者的平均分数来比较多个观察结果。
共纳入 99 名受试者；没有退出同意。来自 25 所医学和 6 所医师助理学校的 37 名住院医师（11 名女性）和 62 名学生（39 名女性）完成了 517 次教学评估。与住院医师的自我评估相比，学生在所有 ER 量表类别中对住院医师的评价更有利（P<0.0001）。在所有亚组比较中（不同类型的学校与毕业后年份[PGY]），这种差异都是显著的。住院医师对不同类型学生（MS 与 PA）的评估没有显示出显著差异。在所有类别中，PGY3 住院医师的自我评估均高于 PGY4 住院医师，可接近性达到显著水平（P=0.0105）。与女性住院医师相比，男性住院医师自我评估的教学水平始终更高，在临床方面差异显著（P=0.0300）。学生对住院医师教学技能的评价与住院医师的性别没有显示出差异。
在使用 ER 量表时，EM 高年级住院医师的 MS 和 PA 学生对 EM 住院医师的教学评价明显高于住院医师的自我评估。尽管男性住院医师通常比女性住院医师更积极地自我评估他们的教学能力，但学生对住院医师的教学评价并没有因性别而有所不同。这些发现表明，如果住院医师实习项目将住院医师的自我评估用于项目评估，住院医师的性别可能会影响自我评分。这一队列可能为急诊科住院医师教学的未来研究提供信息，例如设计未来的住院医师作为教师的课程。
