McKee M D, Steiner-Grossman P, Burton W, Mulvihill M
Department of Family Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
Fam Med. 1998 Feb;30(2):108-12.
Clinicians in community health centers find it difficult to balance the demands of increased productivity and effective teaching. We hypothesized that precepting third-year students would decrease clinical productivity and that many elements related to the quality of the learning experience (e.g., amount of patient contact, student autonomy) would be adversely affected by pressure to see increasing numbers of patients.
Students and preceptors in a 6-week family medicine clerkship completed daily surveys that measured the presence of quantifiable elements of the ambulatory teaching experience. They also rated the overall quality of learning during each session.
For 62 sessions for which both students and preceptors completed evaluations, students rated the overall quality of learning more highly than preceptors. For students, the elements most positively associated with quality of learning were total teaching time and the frequency with which family issues were raised. For preceptors, the elements that predicted quality of learning were the number of patients that students saw independently and total teaching time. The clinical productivity of preceptors did not differ for sessions with and without a student.
Preceptors can be effective teachers who encourage student autonomy and who model behaviors central to family practice, without decreasing productivity.
社区卫生中心的临床医生发现难以平衡提高工作效率和有效教学的需求。我们推测指导三年级学生将降低临床工作效率，并且许多与学习体验质量相关的因素（如患者接触量、学生自主性）会受到看诊患者数量增加所带来压力的不利影响。
参加为期6周家庭医学实习的学生和带教老师完成了每日调查，这些调查衡量了门诊教学体验中可量化元素的存在情况。他们还对每次课程的整体学习质量进行了评分。
在学生和带教老师都完成评估的62次课程中，学生对整体学习质量的评分高于带教老师。对学生而言，与学习质量最正相关的因素是总教学时间和提出家庭问题的频率。对带教老师而言，预测学习质量的因素是学生独立看诊的患者数量和总教学时间。带教老师在有学生和没有学生的课程中的临床工作效率没有差异。
带教老师可以成为有效的教师，鼓励学生自主，并示范家庭医疗实践的核心行为，而不会降低工作效率。
