Schwiebert P, Cacy D, Davis A
Department of Family Medicine, University of Oklahoma College of Medicine, Oklahoma City, USA.
Fam Med. 1996 Jan;28(1):24-8.
Community-based preceptors are increasingly being used to provide clinical experiences for medical students; therefore, the issue of when and how to monitor the appropriateness of teacher-learner interactions in the clinical setting has become increasingly complex and urgent. This paper describes how an audiotaping program in a department of family medicine was designed to account for preceptor and student needs and what this audiotaping experience revealed about the teaching strengths and weaknesses of full-time and volunteer faculty.
Audiotaped case discussions between third-year students and preceptors were evaluated using a structured instrument that reflected important responsibilities of clerkship preceptors. Reviews were compared using chi-square to evaluate for significant differences between university and community preceptors in overall quality of interaction with students and in specific deficiency areas. Ninety-five percent confidence intervals were used to evaluate for significant differences in frequency of occurrence among deficiencies.
A total of 376 audiotaped case discussions were reviewed between July 1992 and June 1994. University preceptors had significantly more "superior" interactions with students than their community peers (P < .05). However, university and community preceptors had nonsignificant differences when specific deficiency areas were compared. Deficiencies in students who were allowed to present cases and assessments occurred significantly less frequently, while deficiencies in preceptors using open-ended questions occurred significantly more frequently than deficiencies in other areas.
This study shows that volunteer faculty performed comparably to full-time university faculty in both the frequency of deficiencies in teacher-learner interactions identified and in the types of deficiencies identified. Both university and volunteer faculty had the most deficiencies in higher-order teaching skills--those involving synthesizing and assessing student knowledge and selecting appropriate questions based on that information. Audiotaped case discussions have a potentially significant role in monitoring teacher-student interactions, particularly on decentralized clinical rotations.
越来越多地利用社区带教教师为医学生提供临床实习机会；因此，在临床环境中何时以及如何监测师生互动的适宜性这一问题变得日益复杂和紧迫。本文描述了家庭医学系的一个录音项目是如何设计以兼顾带教教师和学生的需求的，以及这次录音经历揭示了全职教师和志愿教师在教学方面的优势和不足。
使用一种反映临床实习带教教师重要职责的结构化工具对三年级学生与带教教师之间的病例讨论录音进行评估。使用卡方检验比较评估结果，以评估大学带教教师和社区带教教师在与学生互动的总体质量以及特定不足领域方面的显著差异。使用95%置信区间评估不足发生率之间的显著差异。
在1992年7月至1994年6月期间共审查了376次病例讨论录音。大学带教教师与学生的“优秀”互动显著多于社区带教教师（P <.05）。然而，在比较特定不足领域时，大学带教教师和社区带教教师没有显著差异。允许学生进行病例展示和评估时出现的不足显著较少，而带教教师使用开放式问题时出现的不足比其他领域显著更频繁。
本研究表明，志愿教师在师生互动中发现的不足频率以及所发现的不足类型方面与全职大学教师表现相当。大学教师和志愿教师在高阶教学技能方面存在的不足最多，这些技能涉及综合和评估学生知识以及根据这些信息选择适当的问题。病例讨论录音在监测师生互动方面可能具有重要作用，特别是在分散的临床轮转中。
