Litzelman D K, Stratos G A, Marriott D J, Lazaridis E N, Skeff K M
Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
Acad Med. 1998 Mar;73(3):324-32. doi: 10.1097/00001888-199803000-00022.
To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback.
A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings.
Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores.
Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.
评估为教师提供增强型学生反馈是否能提高临床教学技能。
1994年的一项随机对照试验纳入了印第安纳大学医学院内科的42名主治医师和39名住院医师，他们在医学病房轮转期间对110名学生进行为期一个月的教学。在教学轮转前，干预组教师收到了学生对其教学表现的常模参照图形化总结。在月中，干预组教师收到了基于斯坦福教师发展计划框架的个性化教学有效性指南增强后的学生评分。使用线性模型分析月中和月末学生对教学行为的平均评分。自变量包括表现评分、干预状态、教师身份、教学经验以及与基线评分的交互作用。
在月中和月末，大多数教学类别都发现了与基线表现的复杂交互作用。基线表现分数高的干预组教师比具有相似基线分数的对照组教师获得的学生评分更高；基线表现分数低的干预组教师的评分低于具有可比基线分数的对照组教师。基线分数中等或高的住院医师的评分高于具有可比基线分数的主治医师；基线分数低的住院医师的表现与具有可比基线分数的主治医师相似。
基线表现对于确定最有可能从增强型学生反馈中受益的教师至关重要。教学表现的潜在恶化值得重新考虑是否向基线表现分数低的教师分发学生评分。
