Kelleher Matthew, Kinnear Benjamin, Weber Danielle, Martini Abigail, Santen Sally A, Baker Pamela, Turner Laurah, Warm Eric, Klein Melissa, Schumacher Daniel
University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, US.
University of Cincinnati College of Medicine, Cincinnati, Ohio, US.
Perspect Med Educ. 2024 Nov 25;13(1):592-601. doi: 10.5334/pme.1564. eCollection 2024.
As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated.
In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice.
Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback.
Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME.
随着基于胜任力的医学教育（CBME）在本科医学教育中不断推进，学生们既要追求自身胜任力的发展，又要在住院医师选拔中脱颖而出。在基础临床实习年，了解如何平衡这些看似相互冲突的目标至关重要。
在这项现象学定性研究中，作者描述了15名参与试行路径以实施CBME原则的临床实习学生的经历。这些学生经历了相同的临床实习课程和要求，还包括额外的CBME要素，如辅导、审查其数据的委托委员会、实时可视化评估数据的仪表盘以及作为实践社区进行交流。
学生们分享了他们在临床实习年的成长经历。他们传达了从错误中学习的重要性，但当他们因成绩而面临表现出色的压力时，克服对不完美表现的不适感是一项挑战。这种紧张关系导致他们在印象管理上花费了大量精力，同时还要努力明确自己的角色、厘清期望并学会应对反馈。
临床实习学生在临床环境中面临着一种紧张关系，即侧重于成绩最大化与成长最大化的两种导向之间的矛盾。前者代表着正在消逝的医学教育时代，而后者为未来提供了新的愿景。继续对学生进行评分和排名所带来的威胁似乎与实施CBME的目标不相容。
