I.S. Chua is assistant professor, Department of Pediatrics, Children's National Medical Center, Washington, DC, and clinical instructor, Department of Pediatrics, Stanford School of Medicine, Stanford, California. A.L. Bogetz is associate program director, Department of Pediatrics, Stanford School of Medicine, Stanford, California. P. Bhansali is associate professor, Department of Pediatrics, Children's National Medical Center, Washington, DC. M. Long is associate professor, Department of Pediatrics, University of California, San Francisco, San Francisco, California. R. Holbreich is a medical student, George Washington University School of Medicine and Health Sciences, Washington, DC. T. Kind is professor of pediatrics and associate dean of clinical education, George Washington University School of Medicine and Health Sciences, Washington, DC. M. Ottolini is vice chair of education and professor, Children's National Medical Center, Washington, DC. Y.S. Park is associate professor, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois. M. Lineberry is assistant professor and director of simulation research, assessment, and outcomes, University of Kansas City Medical Center, Kansas City, Kansas. L.E. Hirshfield is assistant professor, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois.
Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S86-S94. doi: 10.1097/ACM.0000000000002914.
To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning.
The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Interrater reliability was examined using kappa. REFLECT scores were analyzed using a chi-square test; essays were analyzed using content analysis.
Eighty percent of eligible students participated. One hundred eighty-nine essays (89 control, 100 intervention) were scored. Thirty-seven percent of the control group attained reflection and critical reflection, the 2 highest levels of reflection, compared with 71% of the intervention group; 2% of the control group attained critical reflection, the highest level, compared with 31% of the intervention group (χ(3, N = 189) = 33.9, P < .001). Seven themes were seen across both groups, 3 focused on physician practice and 4 focused on patients. Patient-centered themes were more common in the intervention group, whereas physician-focused themes were more common in the control group.
Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization.
确定患者汇报访谈对儿科学实习学生深度反思和学习的影响。
作者于 2016 年 5 月至 2017 年 2 月在儿科学实习学生中开展了一项多机构、混合方法、集群随机试验。干预组学生与患者-照护者进行汇报访谈，然后对该经历进行书面反思。对照组学生对一次难忘的患者就诊经历进行书面反思。三位盲审作者根据 4 级 REFLECT 量表对书面反思进行评分，以确定反思的深度。使用 Kappa 检验评估组内一致性。使用卡方检验分析 REFLECT 评分；使用内容分析法分析短文。
80%的合格学生参与了研究。对 189 篇短文（对照组 89 篇，干预组 100 篇）进行了评分。与对照组的 37%（达到反思和批判性反思的最高水平）相比，干预组有 71%达到反思和批判性反思；对照组有 2%达到批判性反思的最高水平，而干预组有 31%（χ(3, N = 189) = 33.9, P <.001）。两组都出现了 7 个主题，其中 3 个主题集中在医生实践上，4 个主题集中在患者上。以患者为中心的主题在干预组中更为常见，而以医生为中心的主题在对照组中更为常见。
患者汇报访谈提供了一种独特的方法，可以通过直接对话和探索患者-照护者在住院期间的经历来深化自我反思。
