Kowlowitz V, Slatt L M, Kollisch D O, Strayhorn G
Department of Family Medicine, University of North Carolina, Chapel Hill 27599-7595, USA.
Acad Med. 1996 Apr;71(4):387-9. doi: 10.1097/00001888-199604000-00018.
To demonstrate the importance of monitoring the clinical experiences and types of supervision that students receive in physicians' offices, in order to ensure quality control during a required clerkship.
In a documentation system introduced in 1991-92, third-year students in the family medicine clerkship at the University of North Carolina at Chapel Hill School of Medicine were asked to complete an optical scan card for every patient they saw. The card information consisted of demographic data, patient continuity, medical problems, types of histories and physical examinations, patient education issues, primary care procedures, and type of supervision. The data were collected from 293 students placed in 63 practices from December 1991 through November 1993.
Hypertension, health maintenance, and upper respiratory infection were the most frequently recorded medical problems. Although the students obtained adequate experience performing focused histories and physicals, their experiences with certain physical examinations (breast, rectal, and genital) were inconsistent. Patterns of supervision by the preceptors varied among practices.
Although the validity of the data has not been assessed, previous literature and other information indicate that the documentation system successfully described the students' clinical experiences. The benefits of implementing such a monitoring system include highlighting the students' lack of certain experiences and making comparisons across sites in order to encourage change among preceptors.
证明监测学生在医生办公室所获得的临床经验和监督类型的重要性，以确保在必修的临床实习期间进行质量控制。
在1991 - 1992年引入的一个记录系统中，北卡罗来纳大学教堂山分校医学院家庭医学临床实习的三年级学生被要求为他们诊治的每位患者填写一张光学扫描卡。卡片信息包括人口统计学数据、患者连续性、医疗问题、病史和体格检查类型、患者教育问题、初级保健程序以及监督类型。数据收集自1991年12月至1993年11月期间在63个医疗机构实习的293名学生。
高血压、健康维护和上呼吸道感染是记录最频繁的医疗问题。尽管学生在进行重点病史采集和体格检查方面获得了足够的经验，但他们在某些体格检查（乳房、直肠和生殖器）方面的经验并不一致。带教老师的监督模式在不同医疗机构之间存在差异。
尽管尚未评估数据的有效性，但先前的文献和其他信息表明该记录系统成功地描述了学生的临床经验。实施这样一个监测系统的好处包括突出学生缺乏某些经验，并进行跨机构比较以鼓励带教老师做出改变。
