Shibli-Rahhal Amal, Brenneman Anthony, McVancel Megan, Rosenbaum Marcy
Department of Internal Medicine, University of Iowa Carver College of Medicine, 1216H MERF, 375 Newton Rd, Iowa City, IA 52242-2600 USA.
Physician Assistant Program, University of Iowa Carver College of Medicine, Iowa City, IA USA.
Med Sci Educ. 2019 Jul 29;29(4):947-957. doi: 10.1007/s40670-019-00779-1. eCollection 2019 Dec.
Effective integration of early clinical experiences (ECE) with preclinical curricula is challenging, given the limited knowledge-base of students and the unpredictability of clinical environments. Integration of ECE with communication skills (CS) training presents an attractive opportunity since CSs apply to all types of clinical encounters and are independent of students' medical knowledge. We present an ECE program that integrates formal CS training with the realities of clinical practice.
Five ECE sessions occur throughout the first year of medical school, each focusing on a specific set of CSs previously introduced in class. Students actively observe preceptors use these skills, briefly practice them, write a critical analysis on each experience, and discuss these in small groups. To identify the perceived usefulness and impact of the ECE on students' CS learning, we analyzed the critical analyses and post intervention evaluations from students and preceptors. Descriptive analyses used SAS for Windows. Thematic content analysis using constant comparison was used to review and code narrative data, and the most commonly referred to impacts, strengths, and limitations of ECE were identified.
Analysis of the students' critical analyses identified the following main themes: (1) integration between ECE and formal CS teaching, (2) importance of effective CS to the delivery of good patient care, and (3) adaptability of CS to specific clinical contexts. Preceptors did not perceive the program as an added burden.
ECE with focused goals, critical analyses, and small group debriefing can be used to effectively teach and reinforce formal classroom CS training.
鉴于学生的知识基础有限以及临床环境的不可预测性，将早期临床经验（ECE）与临床前课程进行有效整合具有挑战性。将ECE与沟通技能（CS）培训相结合提供了一个有吸引力的机会，因为沟通技能适用于所有类型的临床接触，并且独立于学生的医学知识。我们提出了一个将正式的沟通技能培训与临床实践实际情况相结合的早期临床经验项目。
在医学院的第一年共开展五次早期临床经验课程，每次课程聚焦于先前在课堂上介绍过的一组特定沟通技能。学生积极观察带教老师运用这些技能，进行简短练习，针对每次经历撰写批判性分析，并在小组中进行讨论。为了确定早期临床经验对学生沟通技能学习的感知有用性和影响，我们分析了学生和带教老师的批判性分析以及干预后评估。使用SAS for Windows进行描述性分析。采用持续比较的主题内容分析来审查和编码叙述性数据，并确定早期临床经验最常被提及的影响、优势和局限性。
对学生批判性分析的分析确定了以下主要主题：（1）早期临床经验与正式沟通技能教学之间的整合；（2）有效沟通技能对提供优质患者护理的重要性；（3）沟通技能对特定临床环境的适应性。带教老师并不认为该项目是额外的负担。
具有明确目标、批判性分析和小组汇报的早期临床经验可用于有效地教授和强化正式课堂沟通技能培训。
