Carpenter Ciara, Keegan Tom, Vince Gill, Brewster Liz
Lancaster Medical School, Lancaster University, Lancaster, UK.
ST7 Obstetrics and Gynaecology, Health Edication North West - Mersey, Liverpool, UK.
BMJ Simul Technol Enhanc Learn. 2021 Jun 2;7(6):510-516. doi: 10.1136/bmjstel-2020-000836. eCollection 2021.
The transition from medical student to doctor has long been a source of concern, with widespread reporting of new graduates' lack of preparedness for medical practice. Simulation has been suggested as a way to improve preparedness, particularly due to the difficulties in allowing full autonomy for patient care for undergraduate medical students. Few studies look at simulation alone for this purpose, and no studies have compared different simulation formats to assess their impact on preparedness.
This mixed-method study looked at two different simulation courses in two UK universities. Data were collected in two phases: immediately after the simulation and 3-4 months into the same students' postgraduate training. Questionnaires provided quantitative data measuring preparedness and interviews provided a more in-depth analysis of experiential learning across final year and how this contributed to preparedness.
There were no significant differences between the two courses for overall preparedness, stress or views on simulation, and no significant differences in opinions longitudinally. Although the study initially set out to look at simulation alone, emergent qualitative findings emphasised experiential learning as key in both clinical and simulated settings. This inter-relationship between simulation and the student assistantship prepared students for practice. Longitudinally, the emphasis on experiential learning in simulation was maintained and participants demonstrated using skills they had practised in simulation in their daily practice as doctors. Nevertheless, there was evidence that although students felt prepared, they were still scared about facing certain scenarios as foundation doctors.
The results of this study suggest that simulation may positively affect students' preparedness for practice as doctors. Simulation will never be a replacement for real clinical experience. However, when used prior to and alongside clinical experience, it may have positive effects on new doctors' confidence and competence, and, therefore, positively impact patient care.
从医学生到医生的转变长期以来一直是人们关注的焦点，新毕业生对医疗实践准备不足的情况屡见不鲜。有人建议将模拟作为提高准备程度的一种方式，尤其是考虑到本科医学生在患者护理中难以完全自主操作。很少有研究单独针对这一目的研究模拟，也没有研究比较不同的模拟形式以评估它们对准备程度的影响。
这项混合方法研究考察了英国两所大学的两种不同模拟课程。数据分两个阶段收集：模拟结束后立即收集，以及同一批学生研究生培训3至4个月后收集。问卷调查提供了衡量准备程度的定量数据，访谈则对最后一年的体验式学习进行了更深入的分析，以及这如何有助于提高准备程度。
在整体准备程度、压力或对模拟的看法方面，两门课程之间没有显著差异，纵向来看观点也没有显著差异。尽管该研究最初旨在单独研究模拟，但新出现的定性研究结果强调体验式学习在临床和模拟环境中都是关键。模拟与学生助理实习之间的这种相互关系使学生为实践做好了准备。从纵向来看，模拟中对体验式学习的强调得以保持，参与者展示了他们在模拟中练习的技能在作为医生的日常实践中的运用。然而，有证据表明，尽管学生们觉得自己做好了准备，但作为住院医生面对某些情况时他们仍然感到害怕。
这项研究的结果表明，模拟可能会对学生作为医生的实践准备产生积极影响。模拟永远无法替代真实的临床经验。然而，在临床经验之前和同时使用模拟，可能会对新医生的信心和能力产生积极影响，从而对患者护理产生积极影响。
