Medical Education Development Center, Gifu University, Gifu, Japan.
Int J Med Educ. 2020 Jul 24;11:146-154. doi: 10.5116/ijme.5f01.c78f.
In an ageing society, community-based medical education in a home care setting needs to be developed. Drawing on Kolb's experiential learning theory, this study aimed to explore the learning processes in overnight home care by medical trainees in terms of their understanding of terminally ill patients and their conceptualization of themselves as future physicians.
An overnight home care program in which a trainee had to take care of terminally ill patients on his/her own under the supervision of a healthcare team was conducted. Nineteen trainees, including eight medical students and 11 residents, participated in this study. Text data of reflective reports written after the overnight care were collected and thematically analyzed.
The trainees' learning experiences in the program were categorized into four stages: predeparture, concrete experience, reflective observation and abstract conceptualization. Although they had mixed feelings, including anxiety, fear and expectations, at the predeparture stage, they could be actively involved in providing medical care and daily life support and in taking care of dying patients at the patients' homes overnight. By reflecting on their experiences, they gained a sense of achievement and identified the aspects upon which they should improve as future physicians. Subsequently, based on their reflective observation, they conceptualized their approaches to home care and the roles/responsibilities of physicians as healers, which led to professional identity formation.
Overnight home care by medical trainees has the potential as an educational strategy to promote their realistic understanding of home care and facilitate professional identity formation.
在老龄化社会中，需要在社区医疗环境中开展以家庭为基础的医学教育。本研究以 Kolb 的体验式学习理论为基础，旨在探讨医学实习生在家庭护理环境中过夜的学习过程，具体涉及他们对终末期患者的理解以及对自己未来医生角色的概念化。
实施了一项过夜家庭护理计划，在该计划中，受训者必须在医疗团队的监督下独自照顾终末期患者。19 名实习生，包括 8 名医学生和 11 名住院医师，参与了这项研究。收集并对在夜间护理后撰写的反思报告的文本数据进行了主题分析。
实习生在该项目中的学习经历可分为四个阶段：出发前、具体体验、反思观察和抽象概念化。尽管在出发前阶段他们感到焦虑、恐惧和期待等复杂情绪，但他们能够积极参与提供医疗护理和日常生活支持，并在患者家中过夜照顾临终患者。通过反思他们的经验，他们获得了成就感，并确定了作为未来医生需要改进的方面。随后，基于他们的反思观察，他们将家庭护理的方法和医生作为治疗者的角色/责任概念化，从而促进了专业身份的形成。
医学实习生的家庭护理过夜计划具有作为一种教育策略的潜力，可以促进他们对家庭护理的现实理解，并促进专业身份的形成。
