Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Clin Teach. 2023 Apr;20(2):e13562. doi: 10.1111/tct.13562. Epub 2023 Feb 9.
Clinical history taking and physical examination are two of the most important competencies of physicians. In addition to informing diagnoses, these activities build rapport and establish relationships between caregivers and patients. Despite this, emphasis on the assessment of bedside clinical skills is declining. To prepare our students for clinical work, we began a clinical competency, personalised teaching programme in which students perform a history and physical examination in front of a master clinical teacher (MCT) approximately every 2 weeks throughout their core clerkship year. The MCT works with the student in a clinical encounter, providing personalised bedside instruction on all features of being a clinician including bedside manner, history-taking skills, physical examination skills, and clinical reasoning. The MCT then provides an assessment of student's competency development and gives feedback to the student about what they do well and where they have opportunities for growth. Assessment data are collected and tracked longitudinally across the clerkship phase to ensure that each student is progressing developmentally. With over 6000 observations of student performance, we are able to discern competency development and growth over time. We can identify if a student is not improving as expected during their clerkship phase and intervene by providing extra practice and training. This core clerkship teaching programme has been well received by both students and instructors and has led us to pilot this approach during the post-clerkship phase of our medical training.
临床病史采集和体格检查是医生最重要的两项能力。除了提供诊断依据外，这些活动还能建立医护人员与患者之间的融洽关系和联系。尽管如此，对床边临床技能评估的重视程度正在下降。为了让我们的学生为临床工作做好准备，我们开始了一项临床能力个性化教学计划，在该计划中，学生在核心实习年中大约每两周在主临床教师（MCT）面前进行一次病史采集和体格检查。MCT 在临床遇到学生时，会提供有关成为临床医生的所有方面的个性化床边指导，包括医患沟通技巧、病史采集技巧、体格检查技巧和临床推理。然后，MCT 会评估学生的能力发展情况，并向学生反馈他们做得好的地方和他们有哪些成长机会。评估数据是在整个实习阶段进行收集和跟踪的，以确保每个学生都在发展。通过对 6000 多次学生表现的观察，我们能够随着时间的推移辨别出能力发展和成长。我们可以确定学生在实习期间是否没有按预期进步，如果是，我们会通过提供额外的实践和培训来进行干预。这种核心实习教学计划受到了学生和教师的欢迎，并促使我们在医学培训的实习后阶段试行这种方法。
