Elnicki D M, Shumway J M, Halbritter K A, Morris D K
Department of Medicine, West Virginia University, Morgantown 26506, USA.
South Med J. 1996 Jun;89(6):603-8. doi: 10.1097/00007611-199606000-00009.
This descriptive study prospectively examined the performance and supervision of interpretive and procedural skills during an internal medicine clerkship. Students (N = 150) documented having done 7 required and 12 elective skills. Preceptors of required skills were interns (44%), residents (29%), attending physicians (12%), and others (16%). The elective procedures and the percentage of students doing them were as follows: skin tests, 78%; nasogastric tube insertion, 57%; paracentesis, 44%; bone marrow sampling, 35%; lumbar puncture, 34%; thoracentesis, 34%; Papanicolaou smear, 29%; central line placement, 27%; cardioversion, 13%; bladder catheter insertion, 11%; arthrocentesis, 9%; and skin biopsy, 7%. Elective procedures per student ranged from 0 to 9 (mean = 4) and were done less often in the first clerkship group than later in the academic year. Preceptors of electives were interns (46%), residents (39%), and attending physicians (9%). House staff were more likely and faculty less likely to precept electives than required procedures. Students' exposures to these skills are unequal. Their preceptor are generally house staff. To prepare medical students for postgraduate training, technical skills should be specifically addressed in the curriculum.
这项描述性研究前瞻性地考察了内科实习期间解释性技能和程序性技能的表现及指导情况。学生（N = 150）记录完成了7项必修技能和12项选修技能。必修技能的带教老师包括实习医生（44%）、住院医师（29%）、主治医师（12%）和其他人员（16%）。选修操作及其进行操作的学生百分比情况如下：皮肤试验，78%；鼻胃管插入，57%；腹腔穿刺术，44%；骨髓穿刺，35%；腰椎穿刺，34%；胸腔穿刺术，34%；巴氏涂片检查，29%；中心静脉置管，27%；心脏复律，13%；膀胱导管插入，11%；关节穿刺术，9%；皮肤活检，7%。每名学生的选修操作次数从0至9次不等（平均为4次），且在第一实习组中比在学年后期进行得更少。选修操作的带教老师包括实习医生（46%）、住院医师（39%）和主治医师（9%）。与必修操作相比，住院医师更有可能带教选修操作，而教员则可能性较小。学生接触这些技能的机会不平等。他们的带教老师通常是住院医师。为使医学生为研究生培训做好准备，课程中应专门涉及技术技能。
