Institute for General Practice and Interprofessional Health Care, Tübingen University Hospital, Tübingen, Germany.
Med Educ Online. 2021 Dec;26(1):1923114. doi: 10.1080/10872981.2021.1923114.
In Germany, two-week clinical clerkships in university-associated general practices have existed since 2002. Approximately 10,000 medical students participate in these decentral clerkships each year. Empirical information on quality management strategies in decentral learning environments is sparse. This nationwide study aims to describe the current quality management efforts of German family medicine departments in response to negative events. A nationwide three-part mixed methods study on the quality management of family medicine clerkships was conducted. First, individuals from n = 37 family medicine departments involved in the organization of family medicine clerkships were interviewed. Interview transcripts were analyzed with qualitative content analysis. Second, a questionnaire on quality management of decentralized learning environments based on the categories of the analysis was developed and sent to the departments. Three negative event cases in family medicine clerkships were included in the questionnaire. Third, interview and survey data were integrated based on respondents' process descriptions of how each department handled the cases. Of the 37 contacted departments, n = 12 (32%) performed an interview. Major categories of negative events included problems in the student-teacher interaction, didactical challenges, and problematic student behavior. Twenty departments answered at least one questionnaire (54%). Most respondents indicated that their department conducts quality management in decentralized teaching. Negative events in decentral family medicine clerkships occurred at a rate of 66.4 to 179.5 events per 10.000 Students per semester. The mixed-method analysis showed that departments are conscious about quality management issues in decentral learning environments but adhere to heterogeneous local standards. Negative events occur regularly in decentral learning environments. Local quality management processes exist but lack national harmonization. Further outcome-based research is needed to explore the effectiveness and feasibility of quality management strategies. This will become increasingly relevant with an expected upscaled family medicine content.
在德国，自 2002 年以来，大学附属的全科诊所就已经实行了为期两周的临床实习。每年约有 10000 名医学生参加这些分散的实习。关于分散学习环境中质量管理策略的实证信息很少。这项全国性研究旨在描述德国家庭医学系针对负面事件的当前质量管理工作。对家庭医学实习的质量管理进行了一项全国性的三部分混合方法研究。首先，对参与家庭医学实习组织的 n = 37 个家庭医学系的个人进行了访谈。使用定性内容分析对访谈记录进行了分析。其次，根据分析的类别，开发了一个关于分散学习环境质量管理的问卷，并分发给各部门。家庭医学实习中的三个负面事件案例被包括在问卷中。第三，根据受访者描述每个部门如何处理案例的过程，整合访谈和调查数据。在联系的 37 个部门中，n = 12 个（32%）进行了访谈。负面事件的主要类别包括师生互动问题、教学挑战和学生行为问题。有 20 个部门至少回答了一份问卷（54%）。大多数受访者表示，他们的部门在分散教学中进行质量管理。分散家庭医学实习中的负面事件发生率为每 10000 名学生每学期 66.4 至 179.5 起。混合方法分析表明，各部门对分散学习环境中的质量管理问题有一定的认识，但坚持采用不同的地方标准。负面事件在分散的学习环境中经常发生。当地的质量管理流程存在，但缺乏国家协调。需要进一步进行基于结果的研究，以探讨质量管理策略的有效性和可行性。随着家庭医学内容的预期扩大，这将变得越来越重要。
