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在新冠疫情期间,由床边志愿住院患者和Zoom上的教员医生对医学生病史采集技能进行双重指导

Dual Coaching of Medical Clerkship Students' History Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom During the COVID-19 Pandemic.

作者信息

Patel Kush S, Anderson Ronald J, Becker Carolyn B, Taylor William C, Liu Anne F, Varshney Anubodh S, Ali Nadaa B, Nath Barbara J, Pelletier Stephen R, Shields Helen M, Osman Nora Y

机构信息

Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA.

出版信息

Adv Med Educ Pract. 2024 Oct 4;15:923-933. doi: 10.2147/AMEP.S472324. eCollection 2024.

Abstract

PURPOSE

Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students.

PATIENTS AND METHODS

Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts.

RESULTS

Students' history-taking skills - specifically in the domains of communication, medical knowledge and professional conduct - on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training.

CONCLUSION

Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.

摘要

目的

指导是一种已被充分描述的向学习者提供实时、可操作反馈的方式。我们旨在确定由临床教师和真实住院患者进行的双重指导是否能提高临床实习医学生的病史采集技能。

患者与方法

专家临床教师(通过Zoom)直接观察13名临床实习医学生从26名真实的住院患者(亲自)获取病史的过程,之后学生从医生和患者双方获得即时反馈。所有访谈的去识别化音频视频记录由独立评判员使用先前验证的临床评分工具进行评分,以评估两次访谈之间病史采集技能的提高情况。最后,所有参与者完成了一份包含李克特量表问题和自由文本提示的调查问卷。

结果

根据独立评判员在经过验证的评分工具上的评估,学生的病史采集技能——特别是在沟通、医学知识和职业行为方面——在他们的第一次和第二次患者访谈之间没有显著提高。然而,学生对双重指导的评价极高(平均分为1.43,1分为优秀,5分为差),许多人赞赏反馈的针对性和及时性。患者对这次经历的评价也很高(平均分为1.23,1分为优秀,5分为差),指出他们对医学培训有了新的认识。

结论

学生重视获得即时且具体的反馈,而真实患者乐于参与反馈过程。医患双重指导是一种将更多直接观察纳入本科医学教育课程的独特方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4cd/11460274/98c745daa94b/AMEP-15-923-g0001.jpg

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