医学生四年级时其循证医学和紧急临床情况评估表现是否会恶化？来自一所院校的研究结果。

Does Performance on Evidence-Based Medicine and Urgent Clinical Scenarios Assessments Deteriorate During the Fourth Year of Medical School? Findings From One Institution.

机构信息

L.A. Heidemann is clinical assistant professor of internal medicine, University of Michigan Medical School, Ann Arbor, Michigan. C.A. Keilin is a medical student, University of Michigan Medical School, Ann Arbor, Michigan. S.A. Santen was assistant dean of evaluation and assessment and professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan, at the time the study was conducted. She is currently senior associate dean, Evaluation, Assessment, and Scholarship of Learning, Virginia Commonwealth University School of Medicine, Richmond, Virginia. J.T. Fitzgerald is professor, Department of Learning Health Sciences, University of Michigan, and Geriatric Research Education and Clinical Center, Arbor VA Medical Center, Ann Arbor, Michigan. N.L. Zaidi is associate director of advancing scholarship, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan. L. Whitman is standardized patient program manager and educator, University of Michigan Medical School, Ann Arbor, Michigan. E.K. Jones is clinical assistant professor of family medicine, University of Michigan Medical School, Ann Arbor, Michigan. M.L. Lypson is director of medical and dental education, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and adjunct professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. H.K. Morgan is director, Comprehensive Clinical Assessment, and clinical associate professor of obstetrics and gynecology and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

出版信息

Acad Med. 2019 May;94(5):731-737. doi: 10.1097/ACM.0000000000002583.

DOI:10.1097/ACM.0000000000002583

PMID:30640259

Abstract

PURPOSE

The fourth year of medical school (M4) should prepare students for residency yet remains generally unstructured, with ill-defined goals. The primary aim of this study was to determine whether there were performance changes in evidence-based medicine (EBM) and urgent clinical scenarios (UCS) assessments before and after M4 year.

METHOD

University of Michigan Medical School graduates who matched into internship at Michigan Medicine completed identical assessments on EBM and UCS at the beginning of M4 year and 13 months later during postgraduate year 1 (PGY1) orientation. Individual scores on these assessments were compared using paired t test analysis. The associations of academic performance, residency specialty classification, and initial performance on knowledge changes were analyzed.

RESULTS

During academic years 2014 and 2015, 76 students matched into a Michigan Medicine internship; 52 completed identical EBM stations and 53 completed UCS stations. Learners' performance on the EBM assessment decreased from M4 to PGY1 (mean 93% [SD = 7%] vs. mean 80% [SD = 13%], P < .01), while performance on UCS remained stable (mean 80% [SD = 9%] vs. mean 82% [SD = 8%], P = .22). High M4 performers experienced a greater rate of decline in knowledge level compared with low M4 performers for EBM (-20% vs. -4%, P = .01). Residency specialty and academic performance did not affect performance.

CONCLUSIONS

This study demonstrated degradation of performance in EBM during the fourth year and adds to the growing literature that highlights the need for curricular reform during this year.

摘要

目的

医学专业四年级（M4）应该为学生的住院医师培训做好准备，但该学年通常缺乏结构，目标也不明确。本研究的主要目的是确定在 M4 学年前后，基于证据的医学（EBM）和紧急临床情况（UCS）评估是否存在表现变化。

方法

密歇根大学医学院的毕业生在密歇根大学医学中心实习，他们在 M4 学年开始和研究生第 1 年（PGY1）入职时完成了相同的 EBM 和 UCS 评估。使用配对 t 检验分析比较这些评估的个人得分。分析了学业成绩、住院医师专业分类和初始知识变化表现的相关性。

结果

在 2014 年和 2015 年的学年中，有 76 名学生在密歇根大学医学中心实习；52 人完成了相同的 EBM 站，53 人完成了 UCS 站。学习者在 EBM 评估中的表现从 M4 到 PGY1 下降（平均 93%[SD=7%]比平均 80%[SD=13%]，P<.01），而 UCS 的表现保持稳定（平均 80%[SD=9%]比平均 82%[SD=8%]，P=.22）。与 M4 低表现者相比，M4 高表现者 EBM 知识水平下降幅度更大（-20%比-4%，P=.01）。住院医师专业和学业成绩不影响表现。