基于团队与基于带教老师的低年级外科学生任务分配

Team-based versus preceptor-based assignment of junior surgery students.

作者信息

Ephgrave K S, Ferguson K, Kreiter C, Goodwin B

机构信息

Department of Surgery, University of Iowa, College of Medicine, and Veterans Affairs Medical Center, Iowa City, USA.

出版信息

Am J Surg. 1997 Apr;173(4):333-7. doi: 10.1016/S0002-9610(96)00388-1.

DOI:10.1016/S0002-9610(96)00388-1

PMID:9136791

Abstract

BACKGROUND

Clinical evaluations of junior surgery students frequently lack sufficient detail for effective formative or summative feedback. We hypothesized that this was in part due to a lack of personal accountability associated with large general surgery teams, and that altering the format to assign students to specific surgical faculty preceptors rather than to teams would affect the clinical evaluation products.

METHODS

Over a 1-year period, 154 junior medical students grouped into 8 successive clerkships were assigned alternately in the usual Team (3-5 junior students, with 2-4 general surgery faculty, 2-4 residents, and 0-2 senior students) or a new Preceptor format (1-2 students to each faculty preceptor). In order to keep the ratio of students to faculty low, approximately one-third of the Preceptor format students were assigned to subspecialists.

RESULTS

The preceptor format resulted in the use of more adjectives to describe students in the open-ended portions of the faculties' clinical evaluations (mean of 3.2 as compared with 2.5, P = 0.003), and a greater proportion of students recommended for overall clinical Honors (47% as compared with 25%, P = 0.004). The clerkship format had no impact on exam performance, students' perceptions of the faculty, or the amount of students' self-reported clinical activity. Nevertheless, twice as many Team format students felt they had too few patients, whereas twice as many Preceptor students felt their informal instruction had been less than "good."

CONCLUSIONS

Preceptor assignment increased the number of students recommended for Honors, but this did not correlate with students' exam performance. From the students' standpoint, each format had advantages and disadvantages. Limiting the number of students on the general surgery teams and adding structured formative feedback from faculty before the end of the clerkship might give students the instructional advantages of the Preceptor format without sacrificing those of the Team format.

摘要

背景

对低年级外科学生的临床评估往往缺乏足够细节，难以提供有效的形成性或总结性反馈。我们推测，部分原因在于大型普通外科团队缺乏个人责任感，并且改变学生分配方式，将其分配给特定的外科带教教师而非团队，会影响临床评估结果。

方法

在1年时间里，154名低年级医学生被分成8个连续的实习小组，他们被交替分配到常规的团队模式（每组3 - 5名低年级学生，配备2 - 4名普通外科教员、2 - 4名住院医师和0 - 2名高年级学生）或新的带教教师模式（每位带教教师指导1 - 2名学生）。为了保持学生与教员的低比例，大约三分之一的带教教师模式学生被分配给了亚专科医生。

结果

在教员临床评估的开放式部分，带教教师模式下用于描述学生的形容词更多（平均3.2个，而团队模式为2.5个，P = 0.003），并且被推荐获得总体临床荣誉的学生比例更高（47%，而团队模式为25%，P = 0.004）。实习模式对考试成绩、学生对教员的看法或学生自我报告的临床活动量没有影响。然而，团队模式下觉得患者数量太少的学生是带教教师模式下的两倍，而带教教师模式下觉得非正式指导不够“好”的学生是团队模式下的两倍。