Yen-Ju Lin Blossom, Liu Pei-Chun, Ku Kuo-Tung, Lee Cheng-Chun
a Department of Medical Humanities and Social Sciences , College of Medicine, Chang Gung University , Taoyuan , Taiwan, ROC.
b Gynecologic Cancer Research Center , Chang Gung Memorial Hospital , Taoyuan , Taiwan, ROC.
Teach Learn Med. 2019 Jan-Mar;31(1):65-75. doi: 10.1080/10401334.2018.1489815. Epub 2018 Dec 7.
Taiwan's medical undergraduate program at a university or medical center is a continuation of 12 years of compulsory citizenship education rooted in holistic philosophies. Students acquire both technical knowledge and nontechnical attributes, which are necessary for success in further work and life. The early clinical learning experiences of medical students are primarily acquired through clerkships. These clerkships require medical students to apply and extend what they learned during their preclinical education; however, previous studies have explored this issue through examining fragmentary factors such as preclinical course grades and traits but not undertaking comprehensive, whole-person investigations.
To account for the potential benefits of a holistic approach in medical students' learning, we propose three hypotheses: Medical students' preclinical performance on Taiwan's technical and nontechnical higher education assessments are positively associated with their clinical competence (Hypothesis 1) and psychological well-being (Hypothesis 2) during clerkships, and medical students' psychological well-being during clerkships is positively associated with their clinical competence (Hypothesis 3).
We studied a cohort of 65 medical students engaged in clerkships from September 2013 to April 2015. Their preclinical technical knowledge scores-formal curricular grades received from course instructors-were obtained from their medical school's archival dataset. Their nontechnical attributes-moral and social performance scores received from student mentors and physical performance scores received from course instructors-were also obtained from the school's archival data set. The medical students' competence in their 2-year clinical clerkships was measured using the objective structured clinical examination scores from the end of both clerkship years. The medical students' psychological well-being during their 2-year clerkships was measured according to burnout level, which was determined using routine online surveys that employed validated, structured, and self-administered questionnaires at each specialty rotation. Multiple regressions and linear mixed-effects model were employed for statistical analysis.
Our study revealed that higher preclinical technical knowledge predicted superior clinical competence and a higher level of burnout during clerkships. By contrast, higher preclinical nontechnical attributes (i.e., higher preclinical moral, social, and physical performance) predicted lower level of burnout. However, no relationship was discovered between clerkship burnout and the clinical competence of the medical students.
Our study verified the value of a holistic education that encompasses both technical knowledge and nontechnical attributes during the preclinical learning stage for medical students. Our findings can serve as a reference for medical educators designing preclinical educational programs for medical students.
台湾地区大学或医学中心的医学本科课程是12年以整体哲学为基础的公民义务教育的延续。学生既获得技术知识，也培养非技术素养，这些对于他们未来工作和生活的成功至关重要。医学生早期的临床学习经历主要通过临床实习获得。这些实习要求医学生应用并拓展他们在临床前教育阶段所学的知识；然而，以往的研究只是通过考察诸如临床前课程成绩和特质等零散因素来探讨这个问题，而没有进行全面的、针对整个人的调查。
为了探究整体方法在医学生学习中的潜在益处，我们提出三个假设：医学生在台湾地区技术和非技术高等教育评估中的临床前表现与他们在临床实习期间的临床能力（假设1）和心理健康（假设2）呈正相关，并且医学生在临床实习期间的心理健康与他们的临床能力呈正相关（假设3）。
我们研究了一组65名医学生，他们在2013年9月至2015年4月期间参加临床实习。他们的临床前技术知识分数——从课程教师那里获得的正式课程成绩——取自医学院的档案数据集。他们的非技术素养——从学生导师那里获得的道德和社会表现分数以及从课程教师那里获得的身体表现分数——也取自学校的档案数据集。医学生在为期两年的临床实习中的能力通过实习结束时的客观结构化临床考试成绩来衡量。医学生在为期两年的临床实习期间的心理健康状况根据倦怠水平来衡量，倦怠水平通过在每个专科轮转时使用经过验证的、结构化的和自我管理的问卷进行的常规在线调查来确定。采用多元回归和线性混合效应模型进行统计分析。
我们的研究表明，临床前技术知识水平较高预示着临床实习期间有更好的临床能力和更高的倦怠水平。相比之下，临床前非技术素养较高（即临床前道德、社会和身体表现较高）预示着倦怠水平较低。然而，未发现医学生的临床实习倦怠与临床能力之间存在关联。
我们的研究证实了在医学生临床前学习阶段涵盖技术知识和非技术素养的整体教育的价值。我们的研究结果可为为医学生设计临床前教育项目的医学教育工作者提供参考。
