Kuper Ayelet, Boyd Victoria A, Veinot Paula, Abdelhalim Tarek, Bell Mary Jane, Feilchenfeld Zac, Najeeb Umberin, Piquette Dominique, Rawal Shail, Wong Rene, Wright Sarah R, Whitehead Cynthia R, Kumagai Arno K, Richardson Lisa
J Grad Med Educ. 2019 Aug;11(4):460-467. doi: 10.4300/JGME-D-19-00085.1.
Training future physicians to provide compassionate, equitable, person-centered care remains a challenge for medical educators. Dialogues offer an opportunity to extend person-centered education into clinical care. In contrast to discussions, dialogues encourage the sharing of authority, expertise, and perspectives to promote new ways of understanding oneself and the world. The best methods for implementing dialogic teaching in graduate medical education have not been identified.
We developed and implemented a co-constructed faculty development program to promote dialogic teaching and learning in graduate medical education.
Beginning in April 2017, we co-constructed, with a pilot working group (PWG) of physician teachers, ways to prepare for and implement dialogic teaching in clinical settings. We kept detailed implementation notes and interviewed PWG members. Data were iteratively co-analyzed using a qualitative description approach within a constructivist paradigm. Ongoing analysis informed iterative changes to the faculty development program and dialogic education model. Patient and learner advisers provided practical guidance.
The concepts and practice of dialogic teaching resonated with PWG members. However, they indicated that dialogic teaching was easier to learn about than to implement, citing insufficient time, lack of space, and other structural issues as barriers. Patient and learner advisers provided insights that deepened design, implementation, and eventual evaluation of the education model by sharing experiences related to person-centered care.
While PWG members found that the faculty development program supported the implementation of dialogic teaching, successfully enabling this approach requires expertise, willingness, and support to teach knowledge and skills not traditionally included in medical curricula.
对于医学教育工作者而言，培养未来的医生提供富有同情心、公平且以患者为中心的医疗服务仍是一项挑战。对话为将以患者为中心的教育拓展到临床护理提供了契机。与讨论不同，对话鼓励分享权威、专业知识和观点，以促进理解自我和世界的新方式。目前尚未确定在研究生医学教育中实施对话式教学的最佳方法。
我们开发并实施了一个共同构建的教师发展项目，以促进研究生医学教育中的对话式教学与学习。
从2017年4月开始，我们与医师教师试点工作组（PWG）共同构建了在临床环境中准备和实施对话式教学的方法。我们保留了详细的实施记录并采访了PWG成员。在建构主义范式内，采用定性描述方法对数据进行迭代共同分析。持续的分析为教师发展项目和对话式教育模式的迭代变化提供了依据。患者和学习者顾问提供了实践指导。
对话式教学的概念和实践得到了PWG成员的认同。然而，他们表示对话式教学学起来比实施起来更容易，指出时间不足、空间不够以及其他结构问题是障碍。患者和学习者顾问通过分享与以患者为中心的护理相关的经验，为教育模式的深化设计、实施及最终评估提供了见解。
虽然PWG成员发现教师发展项目支持了对话式教学的实施，但成功采用这种方法需要专业知识、意愿以及对传授医学课程中传统上未涵盖的知识和技能的支持。
