Deakin University, School of Medicine, Geelong, Australia.
Med Teach. 2021 Mar;43(3):307-313. doi: 10.1080/0142159X.2020.1839032. Epub 2020 Dec 12.
To compare the participation of rural Longitudinal Integrated Clerkship (LIC) and rural Block Rotation (BR) students in surgical clinical activities.
Third-year medical students from Deakin University's Rural Clinical Schools were invited to record their participation during clinical encounters with ten common surgical conditions, using a descriptive five-point progressive entrustment scale. Participation levels of LIC and BR students were compared for differences, according to clinical task and context.
LIC students recorded greater active participation across all clinical tasks.Highest levels of active participation occurred in General Practice, a setting only LIC students were exposed to at this course stage. BR students recorded the majority of their surgical encounters in the hospital inpatient setting, where their involvement was predominantly observational. Both groups recorded high levels of participation in the Emergency Department.
Active participation in clinical encounters with surgical patients was enhanced by participation in a LIC program and cannot be attributed to the rural context alone. Student participation is influenced by clinical context, presenting the opportunity to reconsider the design of clerkships to include models that facilitate active student participation. Further research is required to investigate the learner, supervisor and contextual factors influencing entrustment decisions within clerkships.
比较农村纵向综合实习（LIC）和农村轮科（BR）学生在外科临床活动中的参与度。
邀请迪肯大学农村临床学校的三年级医学生使用描述性的五分渐进式委托量表，记录他们在与十种常见外科疾病的临床接触中的参与情况。根据临床任务和背景，比较 LIC 和 BR 学生的参与度差异。
LIC 学生在所有临床任务中记录的主动参与度更高。在全科医学中，LIC 学生在这一课程阶段仅接触到该环境，其主动参与度最高。BR 学生记录的大部分外科接触发生在医院住院环境中，他们的参与主要是观察性的。两组学生在急诊科的参与度都很高。
参与 LIC 项目增强了与外科患者的临床接触中的主动参与，而不仅仅是农村环境的影响。学生的参与受到临床环境的影响，这为重新考虑实习的设计提供了机会，以包括促进学生主动参与的模式。需要进一步研究影响实习中委托决策的学习者、主管和环境因素。
