Smith J, Stewart M G, Foggin E, Mathews S, Harris J, Thomas P, Cooney A, Stocker C J
Medical School, University of Buckingham, Hunter Street, Buckingham, MK18 1EG, UK.
BMC Med Educ. 2020 Aug 17;20(1):271. doi: 10.1186/s12909-020-02199-x.
An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals.
SR assessment involved 83 s year MBChB students in facilitated groupwork sessions. Topics discussed were "change and resilience" and "duty of candour". Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback.
There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students' working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P < 0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to "learn experientially" but to so in a "safe environment". Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was "unbeneficial", "empathy is inherent and not learnt", or that sharing emotional problems is simply "moaning".
SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a "facilitated whinge".
让医学生早期接触临床的体验式课程有诸多益处，但这种环境也会带来情感压力。施瓦茨圆桌会议（SR）是应对情感压力的有效方式，在英国和美国的医院中使用越来越广泛。近期研究表明，SR形式对医学生也可能有益。本研究旨在调查第二年医学生参与SR指导是否能获得与医疗保健专业人员相同的益处。
SR评估涉及83名二年级医学学士学生，在小组协作课程中进行。讨论的主题是“变化与适应力”以及“坦诚义务”。学生们完成了一份李克特量表问卷，评估由护理点基金会与施瓦茨基金会合作提出的结果，并提供了自由形式的反馈。
完成率为86%，25%的学生提供了书面反馈。参与者更倾向于认同SR是有益的。SR在增强学生工作关系意识和技能方面的有效性与对SR目的的理解及参与程度密切相关（P < 0.001）。同样，参与SR与以患者为中心的自我报告增强密切相关（P < 0.001）。自由形式的反馈可归纳为五个围绕对SR的理解和参与过程的主题。许多积极评论将SR视为不仅是一个“通过体验学习”的论坛，而且是一个“安全环境”中的论坛。许多负面评论源于学生认为参与SR没有任何益处，比如分享经验是“无益的”，“同理心是与生俱来的而非习得的”，或者分享情感问题只是“抱怨”。
SR是培养对患者和同事的同理心及理解的有效方式。然而，要让学生充分从SR中受益，他们必须参与并理解这个过程。因此，为了将SR成功应用于临床前医学教育，帮助学生认识到SR不仅仅是一个“有引导的抱怨”很重要。
