基于一致性的在线学习对反思的影响。
Impact of an online learning by concordance program on reflection.
机构信息
Département de Médecine Générale et de la Formation Territoriale, Faculté de Médecine, Maïeutique et Sciences de la Santé, 4 rue Kirschleger, Strasbourg, 67085, France.
Département de Médecine Générale, Faculté de Médecine, Besançon, France.
出版信息
BMC Med Educ. 2023 Nov 1;23(1):822. doi: 10.1186/s12909-023-04799-9.
BACKGROUND
Learning by concordance (LbC) is a recent approach that introduces learners to the complexity and uncertainty of clinical practice. Some data on LbC suggest that it stimulates reflection in future clinicians. We developed an online LbC training program on electrocardiogram (ECG) interpretation in general practice at the University of Strasbourg, France, and conducted an exploratory qualitative study to document the impact of this ECG learning-by-concordance training program on reflection in participants.
METHODS
We created 18 clinical vignettes on ECG interpretation based on a review of the literature on frequent and serious cardiovascular diseases that can be identified using an ECG in general practice. The training program was delivered online to postgraduate general practice students in two faculties of medicine. We conducted a qualitative study based on thematic analysis of two focus groups and six individual interviews. Inductive and deductive coding were performed. The five major components of reflection in the Nguyen model were used in the deductive coding: (i) thoughts and actions, (ii) attentive, critical, exploratory, and iterative processes (ACEI), (iii) underlying conceptual frame, (iv) change and (v) self.
RESULTS
Two focus groups and six individual interviews were conducted. The qualitative analysis indicated 203 codes in the focus groups and 206 codes in the individual interviews, which were divided into five groups based on the components of reflection in the Nguyen model: (i) the self; (ii) attentive, critical, exploratory, and iterative interactions with (iii) one's thoughts and actions; and (iv) a view on both the change itself and (v) the underlying conceptual frame. Inductive coding revealed interesting insights into the impact of the identity of the panel members, the absence of a scoring system and the question of uncertainty in ECG reading.
CONCLUSIONS
This study supports the claim that the use of LbC in the context of ECG interpretation could foster reflection in future general practitioners. We discuss future research avenues on instructional design of LbC and reflection.
背景
一致性学习（LbC）是一种最近的方法，它使学习者接触到临床实践的复杂性和不确定性。一些关于 LbC 的数据表明，它激发了未来临床医生的反思。我们在法国斯特拉斯堡大学开发了一个关于心电图（ECG）解读的在线 LbC 培训课程，并进行了一项探索性定性研究，记录了这种心电图学习一致性培训课程对参与者反思的影响。
方法
我们根据文献综述创建了 18 个基于心电图解读的临床病例，这些病例综述了在普通实践中可以通过心电图识别的常见且严重的心血管疾病。培训课程通过在线向两所医学院的研究生普通医生提供。我们基于两个焦点小组和六个个人访谈进行了定性研究，采用主题分析方法。进行了归纳和演绎编码。Nguyen 模型中的反思的五个主要组成部分用于演绎编码：（i）思想和行动，（ii）注意、批判性、探索性和迭代过程（ACEI），（iii）潜在的概念框架，（iv）变化和（v）自我。
结果
进行了两个焦点小组和六个个人访谈。定性分析显示，焦点小组中有 203 个代码，个人访谈中有 206 个代码，这些代码根据 Nguyen 模型中的反思组成部分分为五组：（i）自我；（ii）与（iii）思想和行动的注意、批判性、探索性和迭代交互；（iv）对变化本身和（v）潜在概念框架的看法。归纳编码揭示了一些有趣的见解，涉及面板成员的身份、缺乏评分系统以及 ECG 阅读中的不确定性问题。
结论
这项研究支持了在 ECG 解读背景下使用 LbC 可以促进未来普通医生反思的说法。我们讨论了关于 LbC 和反思的教学设计的未来研究方向。
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