Thomas R, Nieman L Z, Holbert D
Department of Family Medicine, East Carolina University School of Medicine, Greenville, North Carolina.
Fam Med. 1987 Nov-Dec;19(6):449-52.
This study assessed the results of a second-year family medicine course designed to improve student abilities in writing complete assessments and plans from interviews with standardized patients. Sixty-six students attended lectures on the patient's perception of the symptoms of the major causes of death, learned techniques of medical interviewing, saw a model interview by their tutor, received model faculty histories based on American Board of Family Practice Office Record Review Criteria, and received critiques of their own histories. Students in the highest decile recorded twice as much information as those in the lowest decile and recorded as many history items as the faculty member who recorded the most history items. The faculty, however, recorded a more complete list of diagnoses, differential diagnoses, and investigations. Students in the lowest decile recorded the least information and the least number of assessments and plans and did not respond to written critiques. Students in the lowest decile could improve if they were identified early in the course and worked intensively with role models.
本研究评估了一门为期两年的家庭医学课程的成果，该课程旨在提高学生根据对标准化病人的访谈撰写完整评估和诊疗计划的能力。66名学生参加了关于病人对主要死因症状认知的讲座，学习了医学问诊技巧，观看了导师的示范问诊，收到了基于美国家庭医学委员会办公室记录评审标准的示范病史，并收到了对他们自己病史的评语。处于最高十分位数的学生记录的信息是处于最低十分位数学生的两倍，且记录的病史项目数量与记录病史项目最多的教员相同。然而，教员记录的诊断、鉴别诊断和检查清单更为完整。处于最低十分位数的学生记录的信息最少，评估和诊疗计划数量也最少，并且对书面评语没有回应。如果处于最低十分位数的学生在课程早期被识别出来并与榜样进行强化学习，他们是可以取得进步的。
