N. Pandhi is associate professor, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico. M. Gaines is director, Center for Patient Partnerships, and distinguished clinical professor of law, University of Wisconsin Law School, Madison, Wisconsin. D. Deci is associate professor, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. M. Schlesinger is professor of public health and chair, Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. C. Culp is outreach specialist, University of Wisconsin Population Health Institute, Madison, Wisconsin. Z. Karp is health care analytics specialist, healthfinch, Madison, Wisconsin. C. Legler is department coordinator, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. R. Grob is senior scientist, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Acad Med. 2020 Jan;95(1):72-76. doi: 10.1097/ACM.0000000000002893.
Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations.
The authors developed, implemented, and evaluated a self-directed online curriculum followed by a small-group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients' Experiences methodology. Findings from 40 interviews with young adults across the United States about their diverse experiences with depression were summarized online, and the summaries were illustrated by video, audio, and text clips. From August 2016 to April 2017, third-year students completed either this online curriculum and the usual clerkship curriculum or just the usual clerkship curriculum. These intervention and control groups completed pre- and postsurveys.
Students in the intervention group reported that the online curriculum influenced their thinking about depression (51/56) nearly as often as they reported that seeing patients in clinic did (53/56). They also reported greater decreases in personal stigmatizing attitudes toward depression than did students in the control group as measured by the Depression Stigma Scale (5.75-4.02, intervention; 6.50-5.65, control; P = .004). In open-ended responses, students in the intervention group were 13 times more likely to describe key lessons from the curriculum that reflected patient heterogeneity.
Future collaborations include implementing and evaluating this curriculum at other medical schools and developing additional versions based on other illness experiences.
让医学生接触广泛的疾病体验对于教导他们实践以患者为中心的护理至关重要，但学生与具有不同疾病表现的患者的互动往往有限。
作者开发、实施和评估了一个自我指导的在线课程，然后进行了一个小组讨论，重点是关于抑郁教育。该课程基于使用数据库中的个体患者体验方法创建的模块。对来自美国各地的年轻人关于他们与抑郁相关的不同经历的 40 次访谈的结果进行了在线总结，并通过视频、音频和文字剪辑进行了说明。从 2016 年 8 月到 2017 年 4 月，三年级学生完成了在线课程和常规临床实习课程，或者仅完成常规临床实习课程。这些干预组和对照组都完成了前测和后测。
干预组的学生报告说，在线课程对他们对抑郁的思考产生了影响（51/56），几乎与他们报告在诊所看到患者的影响一样频繁（53/56）。与对照组相比，他们还报告了个人对抑郁的污名化态度的更大减少，这是通过抑郁污名量表衡量的（5.75-4.02，干预组；6.50-5.65，对照组；P =.004）。在开放性回答中，干预组的学生更有可能描述出反映患者异质性的课程中的关键经验，这种可能性是对照组的 13 倍。
未来的合作包括在其他医学院实施和评估这一课程，并根据其他疾病经验开发其他版本。
