Kam Alice, Lam Tobi, Chang Irene, Huang Ryan S, Fernandez Nicolas, Richardson Denyse
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Ontario, Canada.
The Institute for Education Research, University Health Network, Ontario, Canadaa.
Can Med Educ J. 2024 Dec 31;15(6):51-57. doi: 10.36834/cmej.78016. eCollection 2024 Dec.
Resident-focused curricula that support competency acquisition in concussion care are currently lacking. We sought to fill this gap by developing and evaluating Spiral Integrated Curricula (SIC) using the cognitive constructivism paradigm and the Utilization-Focused Evaluation (UFE) framework. The evidence-based curricula consisted of academic half-days (AHDs) and clinics for first- and second-year family medicine residents. Our first pilot evaluation had quantitatively demonstrated effectiveness and acceptability but identified ongoing challenges. Here we aimed to better describe how concussion learning is experienced from the learners' perspective to understand why learning challenges occurred.
A qualitative interpretative cohort study was utilized to explore resident perceptions of concussion learning challenges. Participants completed six monthly longitudinal case logs to reflect on their concussion exposure. Semi-structured interviews were conducted.
Residents' beliefs and perceptions of their roles influenced their learning organization and approaches. Challenges were related to knowledge gaps in both declarative knowledge and knowledge interconnections. Through reflection, residents identified their concussion competency acquisition gaps, leading to transformative learning.
This Spiral Integrated Design created vigorous processes to interrogate "concussion" competency gaps. We discussed resident mindsets and factors that hindered "concussion" learning and potentially unintentional negative impacts on the continuity of patient care. Future studies could explore how to leverage humanistic adaptive expertise, cross-disciplines for curriculum development, and evaluation to overcome the hidden curriculum and to promote integrated education and patient care.
目前缺乏以住院医师为中心、支持其在脑震荡护理方面获得能力的课程。我们试图通过使用认知建构主义范式和以利用为重点的评价（UFE）框架来开发和评估螺旋综合课程（SIC），以填补这一空白。基于证据的课程包括面向一年级和二年级家庭医学住院医师的学术半天课程（AHDs）和临床课程。我们的首次试点评估已从定量角度证明了其有效性和可接受性，但也发现了持续存在的挑战。在此，我们旨在更好地从学习者的角度描述脑震荡学习的体验，以理解学习挑战产生的原因。
采用定性解释性队列研究来探讨住院医师对脑震荡学习挑战的看法。参与者完成了六份月度纵向病例日志，以反思他们接触脑震荡的情况。进行了半结构化访谈。
住院医师对自身角色的信念和看法影响了他们的学习组织和方法。挑战与陈述性知识和知识关联方面的知识差距有关。通过反思，住院医师确定了他们在脑震荡能力获取方面的差距，从而实现了变革性学习。
这种螺旋综合设计创造了有力的流程来审视“脑震荡”能力差距。我们讨论了住院医师的思维模式以及阻碍“脑震荡”学习的因素，以及对患者护理连续性可能产生的无意负面影响。未来的研究可以探索如何利用人文适应性专业知识、跨学科进行课程开发和评估，以克服隐性课程，促进综合教育和患者护理。
