Epstein R M, Cole D R, Gawinski B A, Piotrowski-Lee S, Ruddy N B
Highland Hospital Primary Care Institute, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY 14620-2399, USA.
Arch Fam Med. 1998 Mar-Apr;7(2):149-54. doi: 10.1001/archfami.7.2.149.
To explore how students learn in community-based family physicians' offices from the student's point of view.
Each student completing a community-based family medicine clerkship wrote a "critical incident" narrative about an event that was particularly educational. A coding system was developed by a multidisciplinary research team and thematic analysis was conducted.
Critical education experiences were brief, problem-focused, had definitive outcomes, were often collaborative, and led to self-reflection. The most commonly identified mode of learning was "active observation." In most of these situations, the student had significant clinical responsibility, but some involved observation of complex tasks beyond the expectations of a medical student. Most (77%) identified their learning needs after having observed a preceptor, rather than prospectively. Collaboration, coaching, advocacy, and exploring affect were means whereby preceptors and students created a learning environment that students felt was safe, allowed them to recognize their own learning needs, and helped them adopt new behaviors.
These findings broaden the definition of active learning to include active observation and support learner-centered and relational models of learning. Increasing preceptors' awareness of these modes of student learning will enhance the quality of education in ambulatory settings.
从学生的角度探讨学生在社区家庭医生办公室中的学习方式。
每位完成社区家庭医学实习的学生撰写一篇关于一次特别有教育意义的事件的“关键事件”叙述。一个多学科研究团队开发了一个编码系统并进行了主题分析。
关键教育经历简短、以问题为导向、有明确结果、通常具有协作性并引发自我反思。最常确定的学习模式是“主动观察”。在大多数这些情况下，学生承担着重要的临床责任，但有些涉及观察超出医学生预期的复杂任务。大多数（77%）学生是在观察带教老师之后才确定自己的学习需求，而非事先确定。协作、指导、支持和情感探索是带教老师和学生营造学习环境的方式，学生认为这种学习环境是安全的，能让他们认识到自己的学习需求，并帮助他们采用新的行为方式。
这些发现拓宽了主动学习的定义，将主动观察纳入其中，并支持以学习者为中心和基于关系的学习模式。提高带教老师对这些学生学习模式的认识将提高门诊环境中的教育质量。
