van Zuilen Maria Hendrika, Kamath Preetha, Palacios Juan Carlos, Soares Marcio Rotta
University of Miami Miller School of Medicine, Miami, FL.
Wound Manag Prev. 2019 Apr;65(4):42-47.
A paucity of research exists on medical student pressure ulcer education.
This study examines medical student competency outcomes following implementation of a competency-based curriculum that included a pressure ulcer component in its educational intervention.
Over a 5-year period, 645 medical students completed the curriculum, which included a preceptor-led didactic session, online study resources, clinical experiences, and a brief online competency assessment. The assessment involved knowledge of risk factors, wound staging/classification, and prevention and management strategies and included short answer and extended matching questions. A performance standard was set; students not achieving this standard underwent remediation and reassessment. The curriculum was implemented in 3 phases with quality improvement (QI) between each phase. The average competency assessment score and passing rates were determined for each phase. Mean scores for each phase were compared using an analysis of variance test.
Mean competency assessment scores increased significantly after each QI from 17.5 (range 11-23) to 18.3 (range 12-24) to 19.8 (range 12-25) in phases 1, 2 and 3, respectively [F(2,642) = 59.502, P <.001]; the performance standard was raised after both QI points. Overall, 8.7% of students underwent remediation and reassessment, but all achieved the performance standard on their second attempt.
Through a thoughtful QI process that involved carefully aligning all curricular elements (the instructional activities and the assessment), a focused and accountable curriculum was developed that ensured all medical students in the program would achieve a basic level of competency. Increasingly, accreditation agencies are asking medical schools to move toward competency-based curricula. This curriculum represents an important step in this direction.
关于医学生压疮教育的研究较少。
本研究考察了实施基于能力的课程后医学生的能力成果，该课程在教育干预中包含压疮内容。
在5年期间，645名医学生完成了该课程，其中包括由带教老师主导的理论课程、在线学习资源、临床经验以及简短的在线能力评估。评估涉及危险因素知识、伤口分期/分类以及预防和管理策略，包括简答题和扩展匹配题。设定了绩效标准；未达到该标准的学生需接受辅导并重新评估。课程分三个阶段实施，每个阶段之间进行质量改进（QI）。确定每个阶段的平均能力评估分数和通过率。使用方差分析检验比较各阶段的平均分数。
在每次质量改进后，能力评估平均分数显著提高，在第1、2和3阶段分别从17.5（范围11 - 23）提高到18.3（范围12 - 24）再提高到19.8（范围12 - 25）[F(2,642) = 59.502，P <.001]；在两个质量改进点之后都提高了绩效标准。总体而言，8.7%的学生接受了辅导和重新评估，但所有学生在第二次尝试时都达到了绩效标准。
通过一个精心设计的质量改进过程，该过程涉及仔细调整所有课程要素（教学活动和评估），开发了一个重点突出且责任明确的课程，确保该项目中的所有医学生都能达到基本的能力水平。越来越多的认证机构要求医学院校转向基于能力的课程。本课程代表了朝这个方向迈出的重要一步。
