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临床培训期是否支持医学生以患者为中心的观念?

Does clinical training period support patient-centeredness perceptions of medical students?

机构信息

a Department of Medical Education School of Medicine , Akdeniz University , Antalya , Turkey.

b Emergency Service , Gökçebey State Hospital , Zonguldak , Turkey.

出版信息

Med Educ Online. 2019 Dec;24(1):1603525. doi: 10.1080/10872981.2019.1603525.

Abstract

BACKGROUND

Learning environment influences students' professional formation and patient-centered attitudes and behaviors.

OBJECTIVE

The purpose of this study is to investigate how hidden curriculum of learning environment and the previous experience with chronically ill patients affect patient-centeredness perceptions of medical students.

DESIGN

We followed 144 students and determined their opinions on 'ideal patient-centered practice and learning environment' via patient-centeredness questionnaire (PCQ) just before (third year) and at the end (sixth year) of clinical training years of medical school. At the end of each clinical training year (fourth, fifth, and sixth years), we determined experiences of the students about 'patient-centeredness of the learning environment' using a relevant survey called communication, curriculum, and culture (C3) instrument. We also compared PCQ and C3 instrument scores of the participants who had chronically ill patient in their families/friends and who do not.

RESULTS

C3 scores worsened over the years, namely, students faced increasing number of examples against patient centeredness. Final PCQ scores were worse than initial ones. C3 and PCQ scores of the students who had previous experience with chronically ill patients were not different from the scores of the remaining students.

CONCLUSION

Medical students, even those who have a chronically ill patient in their families or friends, lose their idealism about patient centeredness to some degree possibly due to hidden curriculum of the medical school.

摘要

背景

学习环境会影响学生的专业成长和以患者为中心的态度和行为。

目的

本研究旨在探讨学习环境的隐性课程和以前接触慢性病患者的经历如何影响医学生的以患者为中心的观念。

设计

我们跟踪了 144 名学生,在医学院临床培训的前三年(第三年)和结束时(第六年),通过以患者为中心的问卷(PCQ)来确定他们对“理想的以患者为中心的实践和学习环境”的看法。在每个临床培训年(第四、五和六年)结束时,我们使用名为沟通、课程和文化(C3)的相关调查工具来确定学生对“学习环境的以患者为中心”的体验。我们还比较了有慢性疾病患者的家庭/朋友的参与者和没有慢性疾病患者的参与者的 PCQ 和 C3 工具的分数。

结果

C3 分数随着时间的推移而恶化,即学生面对越来越多的非以患者为中心的例子。最终的 PCQ 分数比最初的分数差。有以前接触慢性病患者经历的学生的 C3 和 PCQ 分数与其余学生的分数没有差异。

结论

医学生,即使是那些有慢性病患者的家庭或朋友,也会在一定程度上失去对以患者为中心的理想主义,这可能是由于医学院的隐性课程。

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