Department of Emergency Medicine, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
Department of History of Medicine and Ethics, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
BMC Med Educ. 2021 Oct 22;21(1):536. doi: 10.1186/s12909-021-02970-8.
Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns' patient management skills, ethical decision-making, and reflection skills.
A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group's performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students' performances, and common achievements and mistakes of students.
133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill.
The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.
将临床技能、伦理决策和反思技能相结合已成为医学院临床教学的基石。本研究旨在检测急诊轮转训练营中由讲座、演练、演练后视频汇报和书面反思组成的多模态学习环境方法是否能提高实习医生的患者管理技能、伦理决策和反思技能。
由急诊医学、伦理学和医学教育专家合作创建了多模态学习环境。运用了多种教育技术，包括讲座、案例讨论和角色扮演危机情景。使用预测试和后测试、视频记录表现汇报、视频记录表现评估以及关于自身和小组表现的反思文章来评估学生表现的各个方面。此外，还组织了一次会议，作者们在会上就三个主题进行了方案评估：教学方法的影响、学生表现和学生的共同成就和错误。
共有 133 名学生参加。多选题（MCQ）测试后测成绩略高于前测。前测和后测患者管理问题（PMP）和反思分数之间存在低到中等相关性，女性学生的相关性更为明显。多元线性回归显示，前测和后测 PMP 分数对反思分数有显著贡献。这些结果可能支持更好的患者管理能预测更有力的反思实践。教师观察到，学生喜欢受到表现出色的同龄人的启发，特别是注意到患者、同伴和其他卫生专业人员的共情需求。然而，学生忽略了召唤法医或社会服务，并受到演练背景特征的压力的抑制。
多学科合作创建的多模态学习环境有助于提高实习医生的情景意识的组成部分：患者管理技能、伦理决策和反思实践。在这项研究中，我们创建了一个工具箱，更好地捕捉学生互动的丰富性和多样性。考虑到特定于背景的评估方法的稀缺性以及在医学中广泛使用 MCQ 或通用量表来评估高阶思维技能，这项研究可能被视为在这方面的一个进步。
