Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom.
School of Health Professions Education, Maastricht University, The Netherlands.
Med Teach. 2022 Dec;44(12):1385-1391. doi: 10.1080/0142159X.2022.2098100. Epub 2022 Jul 12.
Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners.
An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory.
Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree = 96, 45%; Agree: = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail.
This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.
开处方是一项常见的任务，通常由初级临床医生执行，但存在潜在的重大危害。尽管如此，医学生通常只在模拟场景或评估中进行处方开具就获得资格。我们实施了一种替代方法：给学生提供带有紫色墨水的钢笔，使他们能够为真正的患者开具处方。我们旨在了解这种干预措施——预开处方，如何为学习者创造最近发展区（ZPD）。
在英国的一所大学，向所有应届医学生分发了一份匿名的、混合方法的评估问卷。分析由基于经验的学习理论指导。
218 名学生对 386 条自由文本评论发表了意见。大多数参与者报告说预开处方帮助他们成为有能力的医生（非常同意=96，45%；同意=110，50%）。预开处方创造了一个 ZPD，参与者可以在真实情境中使用实践工具，同时在失败安全的条件下进行。
这项研究展示了理论上有依据的干预措施如何创造增强学习的条件。它鼓励教育工作者确定常规实践中哪些方面可以委托给学习者，或者由学习者共同执行。在适当的支持下，教育工作者可以创造“安全失败”，使学习者能够安全地参与他们作为新合格临床医生需要应对的真实、高风险和不确定的情况。
