Parrino T A, Parrino N F
Section of General Medicine and Ambulatory Care, Providence Veterans Affairs Medical Center, Brown University School of Medicine, Rhode Island 02908.
Am J Med Sci. 1994 Mar;307(3):163-6. doi: 10.1097/00000441-199403000-00001.
Increasing interest in skills training has been prompted by concerns over risks posed by new, complex clinical environments and the need for medical students to function effectively in such settings. To gain a better idea of the type of instruction currently provided to U.S. medical students, a national survey was conducted in 1991. A survey instrument was prepared after a literature review on practical skills training. Eleven skill and knowledge areas were selected for analysis; six were considered "basic" and five "advanced." Mailings were directed to the deans of 126 U.S. medical schools. Based on a 94% response rate (118/126), the skill and knowledge areas taught most commonly included universal precautions, phlebotomy, intravenous line placement, advanced cardiac life support, and suturing lacerations. Fifty-one (43%) of 118 respondents reported that they conducted "transition courses" for practical skills training. At most such institutions, basic skills were taught more frequently than advanced skills. Where there was no transition course, formal instruction was provided in standing courses and clerkships. The survey indicates that five skills areas are formally taught in the majority of U.S. medical schools. These include universal precautions, phlebotomy, starting intravenous lines, suturing lacerations, and advanced cardiac life support. In most cases, evaluation and certification procedures are infrequent. Further studies are necessary to gain a better idea of what practical training should be undergone by all U.S. medical students.
对新的复杂临床环境带来的风险的担忧以及医学生在这类环境中有效发挥作用的需求，引发了人们对技能培训的兴趣日益浓厚。为了更好地了解目前美国医学生所接受的教学类型，1991年进行了一项全国性调查。在对实践技能培训进行文献综述后，编制了一份调查问卷。选择了11个技能和知识领域进行分析；其中6个被视为“基础”领域，5个为“高级”领域。调查邮件发送给了126所美国医学院校的院长。基于94%的回复率（118/126），最常教授的技能和知识领域包括通用预防措施、静脉穿刺、静脉输液管放置、高级心脏生命支持和伤口缝合。118名受访者中有51名（43%）报告称他们开设了实践技能培训的“过渡课程”。在大多数这类院校中，基础技能的教学比高级技能更频繁。在没有过渡课程的地方，常规课程和临床实习中会提供正式教学。调查表明，美国大多数医学院校正式教授五个技能领域。这些领域包括通用预防措施、静脉穿刺、开始静脉输液、伤口缝合和高级心脏生命支持。在大多数情况下，评估和认证程序并不常见。有必要进行进一步研究，以更好地了解所有美国医学生应该接受哪些实践培训。
