Edwards H M, Balla J I
Med Educ. 1985 Nov;19(6):463-7. doi: 10.1111/j.1365-2923.1985.tb01356.x.
This paper describes the evaluation of an innovative course in clinical decision-making (CDM). A traditional course in neurology taught concurrently to the same group of students by the same teacher was used for comparison. The aim of the course was to introduce students to the basic concepts of CDM as an aid to rational decision-making. The end-point of the evaluation was their perception of the immediate clinical relevance of CDM. It was postulated that by seeing this relevance they would be more likely to change their decision-making behaviour than by simply learning factual content or principles. The evaluation used an ongoing formative approach, including ethnographic analysis, questionnaires, small group discussion and supportive feedback for the teacher. The ongoing evaluation of the course resulted in revisions with increasing relevance within the students' level of experience, changes in sequence of presentations and encouragement of active student participation. A pre-test showed that students had difficulty in the correct assessment of the validity of data and in the correct revision of opinion. Results of the evaluation indicated that the CDM course did not achieve its objective of making students aware of the immediate clinical relevance of CDM. Possible reasons for this include the lack of reinforcement from clinicians suitable for modelling and the context specific nature of the learning of thinking processes. For a CDM course to be successful, it may need to be taught within the context of specific clinical topics. It is suggested that the evaluation approach used here is a cost-effective method when considering innovations in the curriculum and useful for generating further questions for study.
本文描述了对一门临床决策（CDM）创新课程的评估。选取由同一位教师同时教授给同一组学生的传统神经学课程作为对照。该课程旨在向学生介绍临床决策的基本概念，以辅助进行理性决策。评估的终点是学生对临床决策即时临床相关性的认知。据推测，通过认识到这种相关性，他们比仅仅学习事实内容或原则更有可能改变自己的决策行为。评估采用了持续的形成性方法，包括人种志分析、问卷调查、小组讨论以及给教师的支持性反馈。对该课程的持续评估导致课程进行了修订，使其在学生经验水平范围内的相关性不断提高，调整了授课顺序，并鼓励学生积极参与。预测试表明，学生在正确评估数据有效性和正确修正观点方面存在困难。评估结果表明，临床决策课程未实现让学生认识到临床决策即时临床相关性的目标。可能的原因包括缺乏适合作为榜样的临床医生的强化以及思维过程学习的情境特定性。要使临床决策课程取得成功，可能需要在特定临床主题的背景下进行教学。建议这里使用的评估方法在考虑课程创新时是一种具有成本效益的方法，并且有助于提出进一步的研究问题。
