Kane Tanya, Chivese Tawanda, Al-Moslih Ayad, Al-Mutawa Noora A M, Daher-Nashif Suhad, Hashemi Nehdia, Carr Alison
Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
Department of Clinical Academic Sciences, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
BMC Med Educ. 2021 Mar 17;21(1):162. doi: 10.1186/s12909-021-02597-9.
Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students' experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced.
We conducted a cross-sectional study of three student cohorts in 2017-19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students' perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students' perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire.
One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues.
Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students' perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.
尽管在欧洲是常见做法，但在中东地区很少有研究描述早期临床接触（ECE）的效果。这些初医学生所经历的临床学习障碍尚未见报道。本评估报告了在经验回顾（ER）汇报环节支持下，在初级保健中引入ECE的情况。该评估探讨了学生在获取临床和非技术技能方面的经历、常见但报道不足的社会文化问题以及所经历的临床学习障碍。
我们在2017 - 19年对三个学生队列进行了横断面研究：邀请了新医学院的所有二年级和三年级学生参与。主要结果是学生对初级卫生中心实习（PHCP）项目目标的看法以及该项目如何促进学习。次要结果指标是学生对他们在ER环节学习的看法以及在PHCP期间感知到的学习障碍。使用基于李克特量表的问卷来衡量学生对PHCP的看法。
151名学生参与：二年级107名，三年级44名；72.3%为女性。总体而言，大多数学生（>70%）强烈同意或同意PCHP的目的。大多数学生（71%）强烈同意或同意PCHP使他们能够学习患者护理；58%能够观察医生作为榜样，55%能够与家庭医生讨论常见临床问题的处理。大多数学生（二年级 = 62.5%，三年级 = 67%）强烈同意/同意他们现在有信心进行病史采集和检查患者。学生临床学习的障碍包括：学习成果不明确（48.3%）；教师太忙无法教学（41.7%）；对临床医学缺乏理解（29.1%）；害羞（26.5%）；以及觉得与患者交谈困难且尴尬（25.8%）。超过70%的学生报告说ER使他们能够讨论伦理和专业问题。
总体而言，我们的中东学生认为ECE对他们的临床学习有益。PHCP和ER环节共同为新手学习者提供了有益的教育体验。我们建议进一步探索学习障碍，以探究这些新手学生的看法是否体现了潜在的文化敏感性或对新环境的文化适应情况。
