Assistant Professor, Department of Pediatric Hospital Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston.
Education Specialist, Office of Educational Programs, McGovern Medical School at the University of Texas Health Science Center at Houston.
MedEdPORTAL. 2020 Nov 9;16:11029. doi: 10.15766/mep_2374-8265.11029.
Formulating written patient assessments requires the student to synthesize subjective and objective information and use clinical reasoning to reach a diagnosis. Medical students lack this skill, and clinical experience is not enough to acquire it. This session provides a structured process for learning how to formulate a patient assessment.
Third-year medical students participated in a large-group interactive skill session at the beginning of their pediatrics clerkship. Instructors following a scripted model walked students through practice examples to ultimately formulate a complete written patient assessment. The session covered data synthesis, use of appropriate medical terminology, and differential diagnosis development. Students used an audience response system to practice these skills.
Over 1 academic year, 250 medical students participated in six sessions, with an average of 40-50 attendees per session. Over 90% of students completed pre- and postsession written patient assessments. These assessments were evaluated using portions of the Pediatric History and Physical Exam Evaluation grading rubric. The session had a positive effect on patient assessment formulation skills, with a significant increase in scores after the session.
The session improved students' skill in generating more complete written patient assessments. Almost all students found the session valuable regardless of prior clinical experience. Nearly 50% of students felt inadequately prepared to formulate a written patient assessment prior to the session, revealing a skills gap for learners and a curricular teaching gap. This skill session provided a structured method and active learning format for teaching this essential clinical skill.
制定书面患者评估需要学生综合主观和客观信息，并运用临床推理做出诊断。医学生缺乏这种技能，而临床经验不足以获得这种技能。本课程提供了一个学习如何制定患者评估的结构化过程。
三年级医学生在儿科学实习开始时参加了一个大型互动技能课程。教师按照脚本模型引导学生练习实例，最终制定完整的书面患者评估。该课程涵盖了数据综合、使用适当的医学术语和鉴别诊断发展。学生使用观众响应系统练习这些技能。
在一个学年中，有 250 名医学生参加了六次课程，每次课程平均有 40-50 名学生参加。超过 90%的学生完成了课前和课后书面患者评估。这些评估使用儿科病史和体检评估评分标准的部分内容进行评估。该课程对患者评估制定技能产生了积极影响，课程结束后分数显著提高。
该课程提高了学生生成更完整书面患者评估的技能。几乎所有学生都认为该课程有价值，无论他们之前的临床经验如何。近 50%的学生在课程开始前觉得自己没有准备好制定书面患者评估，这表明学习者存在技能差距和课程教学差距。该技能课程为教授这一重要临床技能提供了结构化的方法和主动学习格式。
