Irby D M
Department of Medical Education, University of Washington School of Medicine, Seattle, USA.
Acad Med. 1995 Oct;70(10):898-931. doi: 10.1097/00001888-199510000-00014.
A thematic review was conducted of the 1980-1994 research literature on teaching and learning in ambulatory care settings for both undergraduate and graduate medical education. Included in the review were 101 data-based research articles, along with other articles containing helpful recommendations for improving ambulatory education. The studies suggest that education in ambulatory care clinics is characterized by variability, unpredictability, immediacy, and lack of continuity. Learners often see a narrow range of patient problems in a single clinic and experience limited continuity of care. Few cases are discussed with attending physicians and even fewer are examined by them. Case discussions are short in duration, involve little teaching, and provide virtually no feedback. Excellent teachers are described as physician role models, effective supervisors, dynamic teachers, and supportive persons. Rather than block rotations, students and residents prefer longitudinal teaching programs, which offer continuity-of-care experiences with patients and preceptors. Although little can be concluded about learning outcomes, the studies indicate that some medical students and residents have deficient skills in interviewing, physical examination, and management of psychosocial issues. Based on the reviewed studies, the author recommends facilitating learning by increasing continuity-of-patient-care experiences and contact with faculty members, encouraging collaborative and self-directed learning, providing faculty development, and strengthening assessment and feedback procedures. The author also recommends further research to learn about medical specialties other than internal medicine and family medicine, to describe the knowledge and reasoning of both teachers and learners, and to assess the influences of various educational programs on learning and satisfaction.
对1980 - 1994年间关于本科和研究生医学教育中门诊护理教学与学习的研究文献进行了专题综述。该综述纳入了101篇基于数据的研究文章，以及其他包含改善门诊教育有益建议的文章。研究表明，门诊护理诊所的教育具有多样性、不可预测性、即时性和缺乏连续性的特点。学习者在单个诊所中往往只能看到有限范围的患者问题，并且护理的连续性有限。很少有病例与主治医生讨论，由他们检查的病例更少。病例讨论时间短，教学内容少，几乎没有反馈。优秀教师被描述为医生榜样、有效监督者、有活力的教师和给予支持的人。与分段轮转相比，学生和住院医生更喜欢纵向教学项目，这种项目能提供与患者和带教老师的护理连续性体验。尽管关于学习成果几乎无法得出结论，但研究表明一些医学生和住院医生在问诊、体格检查和心理社会问题管理方面技能不足。基于所综述的研究，作者建议通过增加患者护理连续性体验以及与教员的接触来促进学习，鼓励协作式和自主式学习，提供教员发展培训，并加强评估和反馈程序。作者还建议进一步开展研究，以了解除内科和家庭医学之外的其他医学专业，描述教师和学习者的知识与推理过程，并评估各种教育项目对学习和满意度的影响。
