Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Med Educ. 2021 Jun;55(6):724-732. doi: 10.1111/medu.14444. Epub 2021 Jan 12.
Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships.
In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework.
We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care.
Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale.
当两名学生一起学习新的技能和知识时，就会发生对偶学习。多项研究提供了支持对偶学习在受控模拟环境中的教育原理的证据。然而，对偶学习在临床环境中的作用仍不确定。与模拟环境不同，临床环境中的学习取决于医学生、医生、护士和患者之间的复杂相互作用，这使得对偶学习在实习中不太有价值。本研究的目的是探讨关键利益相关者如何看待在医学生临床实习中实施对偶学习的价值。
在一项建构主义定性研究中，我们对 36 名参与对偶学习的关键利益相关者进行了 51 次半结构化访谈，包括 10 名医学生、12 名医生、5 名护士和 9 名患者。使用主题分析对数据进行归纳编码，然后使用利益相关者理论作为理论框架进行演绎编码。
我们发现，利益相关者普遍对临床环境中对偶学习的教育影响有类似的看法，但对其价值存在分歧。学生强调，对偶学习使他们在与患者的接触中更积极地参与，患者也不介意有两名学生在场。医生和护士认为对偶学习扰乱了服务与培训之间的平衡，并报告说，它不符合他们对良好患者护理的看法。
对偶学习使学生在临床实习中更加积极主动，但它很容易扰乱服务与培训之间的平衡。这种干扰可能会因不同利益相关者群体之间优先级和价值观的平衡变化以及对监督医生和护士的隐性教学义务更加明确而加剧。因此，无论对偶学习的教学原理如何，医生和护士可能不会认为其在临床环境中具有价值。
