Prislin M D, Lenahan P, Shapiro J, Radecki S
Department of Family Medicine, University of California, Irvine, USA.
Fam Med. 1997 Jul-Aug;29(7):483-7.
The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum.
Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared.
No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders.
Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.
家庭医学住院医师行为科学培训的教育效果以及各种教育方法如何影响毕业生的临床实践活动，目前尚不清楚。在本研究中，我们将传统的理论与临床模块轮转教学方法与基于问题的学习（PBL）及临床实践、体验式行为科学课程进行比较。
通过对干预前后两组人群进行调查，以评估毕业生对广泛行为科学概念的理解、管理特定行为状况的能力以及他们的行为科学实践活动。这两组人群分别是加利福尼亚大学欧文分校1984 - 1988年的家庭医学住院医师项目毕业生（58人）和1993 - 1995年的住院医师毕业生（27人）。同时还比较了美国家庭医学委员会（ABFP）在职培训考试成绩。
在自我感知能力和ABFP考试成绩方面未发现显著差异。干预后组的住院医师毕业生在临床实践中更常涉及抑郁症、婚姻咨询和饮食失调问题，并且报告在应对情境压力和性功能障碍方面的临床实践活动更频繁。干预后组报告较少参与酒精和药物滥用问题的处理。该组还报告在注意力缺陷障碍、学习障碍和饮食失调方面的实践活动超出了其自我感知的能力水平。
参与PBL - 临床体验课程的人员在处理几种常见行为问题时报告了更高水平的临床实践活动。这些差异似乎不太可能是由于课程变化导致的。需要进一步研究教育及其他因素对住院医师毕业生临床实践活动的影响。
