Huang Ryan S, Sood Tushar, Nelms Matthew, Wintraub Lauren, Leung Fok-Han
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Health Centre at 80 Bond, St. Michael's Hospital, 80 Bond Street, Toronto, ON, M5B1X2, Canada.
BMC Med Educ. 2025 Jul 1;25(1):883. doi: 10.1186/s12909-025-07578-w.
Evaluating resident physicians' competencies is critical in medical education to ensure high standards of patient care and professional development. Field notes are increasingly used as reflective tools in postgraduate medical education. Despite their growing use, skepticism about their effectiveness persists. This study aims to identify challenges with learner engagement in field notes and gather suggestions for operational improvements.
A qualitative study was conducted in the Department of Family & Community Medicine at the University of Toronto. Semi-structured interviews were conducted with seven postgraduate year one and year two family medicine residents. The interviews focused on residents' experiences and challenges with field notes. Data were analyzed using inductive thematic analysis to develop a comprehensive codebook, in alignment with Braun and Clarke's framework.
Several key challenges with the use of field notes were identified including the redundancy of feedback, sporadic utilization, and time constraints for preceptors. Residents also expressed uncertainty about the expectations for using the tool and identified it as complex and cumbersome. Operational suggestions for improvement included the development of a mobile-friendly platform, streamlined functionality, a standardized and integrated feedback system, and clearer guidelines for use.
The study highlighted significant challenges in the use of field notes within family medicine training programs and underscored the need for technological and procedural innovations to improve their effectiveness. Addressing these challenges through user-friendly design, clear guidelines, and integrated support systems could transform field notes into a more robust tool for competency-based medical education, benefiting residents, preceptors, and the broader medical community.
在医学教育中，评估住院医师的能力对于确保高标准的患者护理和职业发展至关重要。实地记录越来越多地被用作研究生医学教育中的反思工具。尽管其使用越来越广泛，但对其有效性的怀疑仍然存在。本研究旨在确定实地记录中学习者参与度方面的挑战，并收集改进操作的建议。
在多伦多大学家庭与社区医学系进行了一项定性研究。对7名一年级和二年级的家庭医学住院医师进行了半结构化访谈。访谈重点关注住院医师在实地记录方面的经历和挑战。使用归纳主题分析法对数据进行分析，以制定一个全面的编码手册，符合布劳恩和克拉克的框架。
确定了使用实地记录的几个关键挑战，包括反馈的冗余、使用的零星性以及带教教师的时间限制。住院医师还对使用该工具的期望表示不确定，并认为它复杂且繁琐。改进的操作建议包括开发一个便于移动设备使用的平台、简化功能、建立标准化和综合的反馈系统以及更清晰的使用指南。
该研究突出了家庭医学培训项目中使用实地记录的重大挑战，并强调需要进行技术和程序创新以提高其有效性。通过用户友好的设计、清晰的指南和综合支持系统来应对这些挑战，可以将实地记录转变为基于能力的医学教育中更强大的工具，使住院医师、带教教师和更广泛的医学界受益。
