殊途同归：探索纵向整合临床实习中的学习机制。

Same but Different: Exploring Mechanisms of Learning in a Longitudinal Integrated Clerkship.

机构信息

M. Mylopoulos is associate professor, Department of Paediatrics, curriculum scientist, MD Program, and scientist and associate director, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. K. Kulasegaram is assistant professor, Department of Family and Community Medicine, and scientist, MD Program and The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. K. Weyman is associate professor, St. Michael's Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. S. Bernstein is associate professor, Department of Paediatrics, and clerkship director, MD Program, University of Toronto, Toronto, Ontario, Canada. M.A. Martimianakis is associate professor and director, Medical Education Scholarship, Department of Paediatrics, and scientist and associate director, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada.

出版信息

Acad Med. 2020 Mar;95(3):411-416. doi: 10.1097/ACM.0000000000002960.

DOI:10.1097/ACM.0000000000002960

PMID:31436627

Abstract

PURPOSE

Longitudinal integrated clerkships (LICs) are a widely used method of delivering clerkship curricula. Although there is evidence that LICs work and core components of LIC training have been identified, there is insufficient understanding of which components are integral to why they work. To address this question, this research explored how students experienced the first year of an LIC program. The aim was to use participants' understanding of their learning experiences to identify potential mechanisms of the LIC curriculum model.

METHOD

Thirty-two interviews were conducted with 13 University of Toronto students, 7 LIC and 6 block rotation students from the same site, from October 2014 to September 2015. A thematic analysis was performed iteratively to explore participants' understanding of their key learning experiences and outcomes.

RESULTS

Participants in both cohorts described their key learning outcome as integration and application of knowledge during patient care. Experiences supporting this outcome were articulated as longitudinal variable practice and continuity of relationships with preceptors and patients. Critically, these experiences manifested differently for the 2 cohorts. For block students, these learning experiences appeared to reflect the informal curriculum, whereas for LIC students, learning experiences were better supported by the LIC formal curriculum.

CONCLUSIONS

The results illustrate the importance of learning experiences that support longitudinality and continuity. By also emphasizing variability and knowledge integration, they align with literature on expert development. Notably, many of the learning experiences identified resulted from informal learning and thus support going beyond the formal curriculum when evaluating the effectiveness of curricula.

摘要

目的

纵向综合实习（LIC）是一种广泛使用的实习课程教学方法。虽然有证据表明 LIC 有效，并且已经确定了 LIC 培训的核心组成部分，但对于哪些组成部分是其有效的关键因素，还缺乏足够的理解。为了解决这个问题，本研究探讨了学生在 LIC 项目的第一年的体验。目的是利用参与者对学习经验的理解，确定 LIC 课程模式的潜在机制。

方法

2014 年 10 月至 2015 年 9 月，在同一地点对来自多伦多大学的 13 名学生（7 名 LIC 学生和 6 名模块轮转学生）进行了 32 次访谈。采用主题分析方法，迭代探索参与者对其主要学习经验和结果的理解。

结果

两个队列的参与者都将其主要学习成果描述为在患者护理过程中整合和应用知识。支持这一结果的经验被表述为纵向变量实践以及与导师和患者关系的连续性。至关重要的是，这两个队列的学习经验表现不同。对于模块轮转学生，这些学习经验似乎反映了非正式课程，而对于 LIC 学生，学习经验则得到 LIC 正式课程更好的支持。