弥合基础医学教育与临床培训之间的差距：过渡到实习课程对医学生实习表现的影响。

Closing the Gap Between Preclinical and Clinical Training: Impact of a Transition-to-Clerkship Course on Medical Students' Clerkship Performance.

机构信息

M.S. Ryan is associate professor and assistant dean for clinical medical education, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289. M. Feldman is associate professor and assistant director for research and evaluation, Center for Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, Virginia. C. Bodamer is assistant professor and simulation educator, Center for Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, Virginia. J. Browning is director of academic information systems, Virginia Commonwealth University School of Medicine, Richmond, Virginia. E. Brock was professor of obstetrics and gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, at the time this work was completed. She is retired now. C. Grossman is associate professor and interim medical director of human simulation, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

出版信息

Acad Med. 2020 Feb;95(2):221-225. doi: 10.1097/ACM.0000000000002934.

DOI:10.1097/ACM.0000000000002934

PMID:31397707

Abstract

PROBLEM

Medical students typically perform worse on clinical clerkships that take place early in their training compared with those that occur later. Some institutions have developed transition-to-clerkship courses (TTCCs) to improve students' preparedness for the clinical phase of the curriculum. Yet, the impact of TTCCs on students' performance has not been evaluated.

APPROACH

The authors developed and implemented a TTCC at Virginia Commonwealth University School of Medicine and measured its impact on students' clerkship performance. During the 2014-2015 academic year, they introduced a 2-week intersession TTCC. The goal was to improve students' readiness for clerkships by fostering the knowledge, skills, and attitudes required to care for patients throughout a hospitalization. The TTCC included panel discussions, skills development sessions, case-based workshops, and a 4-station standardized patient simulation. The authors assessed the feasibility of designing and implementing the TTCC and students' reactions and clerkship performance.

OUTCOMES

The total direct costs were $3,500. Students reacted favorably and reported improved comfort on entering clerkships. Summative performance evaluations across clerkships were higher for those students who received the TTCC with simulation compared with those students who received the standard clerkship orientation (P < .001-.04, Cohen's d range = 0.23-0.62). This finding was particularly apparent in those clerkships that occurred earlier in the academic year.

NEXT STEPS

Future plans include evaluating the impact of the TTCC on student well-being and incorporating elements of the TTCC into the preclinical curriculum.

摘要

问题

与后期的临床实习相比，医学生在早期培训阶段的临床实习中表现通常较差。一些机构已经开发了过渡到实习课程（TTCC），以提高学生对课程临床阶段的准备。然而，TTCC 对学生表现的影响尚未得到评估。

方法

作者在弗吉尼亚联邦大学医学院开发并实施了 TTCC，并测量了其对学生实习表现的影响。在 2014-2015 学年，他们引入了为期两周的期中 TTCC。其目标是通过培养在整个住院期间照顾患者所需的知识、技能和态度，提高学生的实习准备情况。TTCC 包括小组讨论、技能发展课程、基于案例的研讨会和四个标准化患者模拟站。作者评估了设计和实施 TTCC 的可行性，以及学生的反应和实习表现。