Turc G, Terrier B, Bats A-S, Ngo C, Ranque B, Calvet D
Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité Inserm U894, centre de psychiatrie et neurosciences, Paris, France.
Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Rev Med Interne. 2018 Dec;39(12):905-911. doi: 10.1016/j.revmed.2018.09.001. Epub 2018 Oct 2.
Since 2014-2015, practical teaching of clinical observation skills for 2 year medical students at our faculty has been discipline-based; previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study.
Pre-reform 3 and post-reform 2 and 3 year medical students (n=62, n=71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2 year was different between students who had received neurological teaching from a neurologist (n=29) or another specialist (n=102).
The median [interquartile range] number of items acquired by post-reform 3 year students (4 [2-5]) was higher than that of pre-reform 3 year students (2 [1-3]; P<0.001), but lower than that of post-reform 2 year students (5 [4-6]; P=0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist.
Acquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills; (2) a training of clinical lecturers to teach a limited list of educational objectives; and (3) the introduction of a practical test at the end of the 2 year of medical studies. However, there was a decline in clinical observation skills between 2 and 3 year medical students.
自2014 - 2015年以来，我校医学院二年级医学生临床观察技能的实践教学采用了基于学科的方式；在此之前，每位临床讲师都必须涵盖所有医学领域。我们在一项前后对照研究中评估了这项教学改革对医学生神经学检查技能的影响。
改革前的三年级以及改革后的二年级和三年级医学生（分别为n = 62、n = 71和52）必须完成7项神经学检查项目，这些项目都预先设定了表现标准。随后，我们评估了在两年制医学学习结束时的测试中，接受神经科医生（n = 29）或其他专科医生（n = 102）进行神经学教学的学生在神经学检查技能方面的平均成绩是否存在差异。
改革后三年级学生掌握的项目中位数[四分位间距]（4 [2 - 5]）高于改革前三年级学生（2 [1 - 3]；P < 0.001），但低于改革后二年级学生（5 [4 - 6]；P = 0.01）。由神经科医生或其他专科医生培训的学生在实践测试中获得的平均成绩没有差异。
教学改革后，神经学检查技能的掌握情况有所改善，改革内容包括：（1）基于学科的临床观察技能实践教学；（2）对临床讲师进行培训，使其教授有限的教育目标清单；（3）在两年制医学学习结束时引入实践测试。然而，二年级和三年级医学生的临床观察技能出现了下降。
