Grant J, Marsden P
Open University, Milton Keynes, UK.
Med Educ. 1988 May;22(3):173-9. doi: 10.1111/j.1365-2923.1988.tb00002.x.
We have studied the knowledge of students and clinicians that they actually used to follow up four problems in general medicine. Some unexpected similarities and differences in their readily accessible or primary knowledge were found in groups from first-year clinical medical students to consultants. There is no linear increase in the quantity of primary knowledge with experience, but qualitative changes are very much more important. At all levels individuals show a remarkable dissimilarity in the knowledge they use to solve clinical problems, so that the bulk of personal knowledge used is individual. Comparatively rarely do people use the same knowledge to solve any one clinical problem. However, there is evidence of a general tendency towards increasing uniformity in knowledge as a result of the medical school years. After houseman level, individuality increases again. These changes result in consultants achieving an identical profile to first-year clinical medical students in terms of the extent to which their primary knowledge bases are held individually or in common. These findings suggest that consultant expertise is actually based on individual experience rather than a common core of knowledge. The influence of medical school in providing such a common knowledge base is (1) limited and (2) reversed by clinical practice. The results suggest the necessity for increased vocational and practice-oriented components in medical education, particularly in postgraduate education.
我们研究了学生和临床医生在普通医学中实际用于追踪四个问题的知识。从一年级临床医学生到顾问，在他们易于获取的或主要的知识方面发现了一些意想不到的异同。随着经验的增加，主要知识的数量并没有线性增长，但质的变化更为重要。在各个层面上，个体在用于解决临床问题的知识方面表现出显著差异，因此所使用的个人知识大部分是个体化的。相对很少有人使用相同的知识来解决任何一个临床问题。然而，有证据表明，由于医学院校的学习，知识有逐渐趋于统一的总体趋势。在实习医生阶段之后，个体差异再次增加。这些变化导致顾问在其主要知识库是个人持有还是共同持有的程度方面，与一年级临床医学生呈现出相同的情况。这些发现表明，顾问的专业知识实际上是基于个人经验，而不是共同的知识核心。医学院校在提供这样一个共同知识库方面的影响是：（1）有限的；（2）被临床实践所逆转。结果表明，医学教育，尤其是研究生教育，有必要增加职业和实践导向的内容。
