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学生和导师对远程“学生-患者”咨询的体验。

Students' and tutors' experiences of remote 'student-patient' consultations.

机构信息

Primary Care Population Health Department, University College London, London, UK.

School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.

出版信息

Med Teach. 2023 Sep;45(9):1038-1046. doi: 10.1080/0142159X.2023.2170777. Epub 2023 Feb 6.

Abstract

BACKGROUND

Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning.

AIM

To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool.

METHOD

A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed.

RESULTS

Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student-patient interaction, and student-doctor interaction.

DISCUSSION

Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students' psychological safety. Frequent debriefs could ameliorate this risk and positively impact student-doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients.[Box: see text].

摘要

背景

远程咨询已经成为医学生初级保健临床体验的一部分,但关于其对学习的影响的研究甚少。

目的

描述全科医生教育者和医学生在使用学生主导的远程咨询作为教育工具方面的经验。

方法

在英国的四所医学院进行了一项定性、探索性研究。有目的地对全科医生教育者和医学生进行了抽样和访谈。

结果

出现了九个主题:实际应用、自主性、启发式、安全性、未分化患者分诊、临床推理、患者纳入学生教育、医患互动和师生互动。

讨论

远程咨询已经成为临床实习经历的一部分。这使得学生接触到更广泛的临床表现。通过远程咨询实践了口头沟通、病史采集、分诊和临床推理技能,但缺乏检查技能的发展。学生发现建立融洽关系更具挑战性,但通过与患者有更多的时间相处,这种情况有所缓解。远程咨询被认为存在更大的临床风险,这可能对学生的心理安全产生负面影响。频繁的汇报可以减轻这种风险,并对师生关系产生积极影响。学生的自主性和独立性因更多的参与和责任而增加。预先选择患者可能会有所帮助,但可能会使学生接触到复杂性较低的患者。

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