Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Department of Surgery, University Hospital Pleven, Pleven, Bulgaria.
PLoS One. 2020 May 29;15(5):e0233748. doi: 10.1371/journal.pone.0233748. eCollection 2020.
Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaLplus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaLplus is part of the Department of General Practice's longitudinal curriculum for Family Medicine.
This study aims to assess whether the AaLplus program has positive effects on students' clinical skill development and subjective confidence in history taking, physical examination and venepuncture.
From 2015 to 2019, we asked all AaLplus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students' performance in all taught skills using standardized checklists.
From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient's history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82-4.36, SDs range 0.74-0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaLplus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as "helpful" or "very helpful" (means for different stations 4.69-4.76, SDs 0.50-0.70).
AaLplus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program's routine viability. Further studies are needed to analyze if programs like AaLplus could have an impact on the number of graduates choosing career in Family Medicine.
病史采集和体格检查等基本医学技能是临床工作概况的重要组成部分，但在传统的临床前课程中却被忽视了。近邻教学计划 AaLplus [活体解剖加] 教授临床前学生基本医学技能，特别是病史采集、体格检查和静脉穿刺。它是海德堡大学前四个学期非常受欢迎的必修课程（每年 320 名学生，每学期 9 小时），并在形成性客观结构化临床考试（OSCE）结束，学生在考试中接受关于他们表现的结构化深入反馈。AaLplus 是全科医学系纵向家庭医学课程的一部分。
本研究旨在评估 AaLplus 计划是否对学生的临床技能发展和对病史采集、体格检查和静脉穿刺的主观信心产生积极影响。
从 2015 年到 2019 年，我们要求所有 AaLplus 参与者对该计划进行评分，并对 5 分李克特量表（最小 1，最大 5）进行自我评估他们的医学技能。在 4 站 OSCE 中，经过培训的导师使用标准化检查表对学生在所有教授技能中的表现进行评分。
从 2015 年到 2019 年，共收回 1534 份问卷（回复率=98.6%，女性占 52.7%）。课程结束后，学生觉得自己能够进行病史采集（平均值 3.97，标准差=0.75）和进行体格检查（平均值范围 3.82-4.36，标准差范围 0.74-0.89）以及静脉穿刺（平均值 4.12，标准差=0.88）。绝大多数学生表示他们在 AaLplus 计划中获得了这些技能。在 OSCE 中，81.9%的学生通过了病史采集，93.1%的学生通过了体格检查，95.4%的学生通过了静脉穿刺（共 1556 名学生）。学生对 OSCE 期间收到的反馈大多评价为“有帮助”或“非常有帮助”（不同站点的平均值为 4.69-4.76，标准差为 0.50-0.70）。
AaLplus 是医学研究临床前阶段同伴教学计划的一个积极范例。它成功地培训了低年级学生的基本医学能力，并提高了他们对自己技能的信心。有很高比例的学生通过了形成性 OSCE，并对其给予积极评价。一贯的高分表明该计划具有常规可行性。需要进一步研究分析像 AaLplus 这样的计划是否会对选择家庭医学职业的毕业生人数产生影响。
