临床不确定性学习：一项对急诊住院医师和主治医生临床反馈感知的多中心调查。

Clinical learning in the context of uncertainty: a multi-center survey of emergency department residents' and attending physicians' perceptions of clinical feedback.

机构信息

Chang-Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

BMC Med Educ. 2019 May 29;19(1):174. doi: 10.1186/s12909-019-1597-8.

DOI:10.1186/s12909-019-1597-8

PMID:31142306

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6542138/

Abstract

BACKGROUND

Feedback is an essential part of clinical teaching and learning, yet it is often perceived as unsatisfactory in busy clinical settings. Clinical teachers need to balance the competing demands of clinical duty and feedback provision. The influence of the clinical environment and the mutual relationship between feedback giving and seeking has been inadequately investigated. This study therefore aimed to quantify the adequacy, perceptions, and influential factors of feedback provision during resident training in emergency departments (EDs).

METHODS

A multicenter online questionnaire study was undertaken. The respondents comprised ED residents and clinical teachers from four teaching hospitals in Taiwan. The questionnaire was developed via an expert panel, and a pilot study ensured validity. Ninety clinical teachers and 54 residents participated.

RESULTS

The respondents reported that the majority of feedback, which usually lasted 1-5 min, was initiated by the clinical teachers. Feedback satisfaction was significantly lower for the clinical teachers than for the residents (clinical teachers M = 13.8, SD = 1.83; residents M = 15.3, SD = 2.14; p < 0.0001), and positive feedback was provided infrequently in clinical settings (31.1%). Both groups of participants admitted hesitating between providing/seeking feedback and completing clinical work. Being busy, the teachers' clinical abilities, the learners' attitudes, and the relationship between both parties were reported as the most influential factors in feedback provision.

CONCLUSION

ED clinical feedback provision is often short, circumstantial, and initiated by clinical teachers. Providing or seeking feedback appears to be an important part of clinical learning in the context of uncertainty. The importance of the relationship between the feedback seeker and the provider highlights the interactive, reciprocal nature of clinical feedback provision.

摘要

背景

反馈是临床教学和学习的重要组成部分，但在繁忙的临床环境中，它常常被认为不尽如人意。临床教师需要平衡临床职责和反馈提供之间的竞争需求。临床环境的影响以及反馈给予和寻求之间的相互关系尚未得到充分研究。因此，本研究旨在量化住院医师培训期间在急诊科提供反馈的充分性、感知和影响因素。

方法

进行了一项多中心在线问卷调查研究。受访者包括来自台湾四家教学医院的急诊科住院医师和临床教师。问卷由专家小组开发，并进行了试点研究以确保有效性。共有 90 名临床教师和 54 名住院医师参与了调查。

结果

受访者报告说，大多数反馈（通常持续 1-5 分钟）是由临床教师发起的。临床教师的反馈满意度明显低于住院医师（临床教师 M=13.8，SD=1.83；住院医师 M=15.3，SD=2.14；p<0.0001），并且在临床环境中很少提供积极的反馈（31.1%）。两组参与者都承认在提供/寻求反馈和完成临床工作之间犹豫不决。忙碌、教师的临床能力、学习者的态度以及双方之间的关系被报告为提供反馈的最具影响力的因素。