Gjerde C L, Levy B T, Xakellis G C
Department of Family Medicine, University of Wisconsin, Madison, USA.
Fam Med. 1998 Jun;30(6):410-6.
There is a belief among family medicine educators that a third-year family medicine rotation provides unique clinical learning experiences, but there is limited research to support this belief. This study identified clinical skills performed by third-year medical students only during a community-based family medicine preceptorship, even when the family medicine rotation occurs after all other required clerkships.
During 6 academic years (1990-1996), 87 third-year students completed the family medicine preceptorship as their final rotation and rated their experience with 80 clinical activities (preventive health care, clinical problem management, and procedures) after completing all required clerkships other than family medicine and again after the family medicine preceptorship. Ratings measured whether the activities occurred on the family medicine rotation, only on other rotations, or combinations of both.
More than 50% of students who performed five preventive skills (health maintenance for adolescents, young adults, middle-aged adults, or senior citizens and weight control counseling) gained that experience only during the family medicine preceptorship. The majority of students actively managed six clinical problems (acute strains and sprains, low back pain, sinusitis, strep throat, acute bronchitis, and osteoarthritis) uniquely during the family medicine preceptorship. The preceptorship offered few unique opportunities to perform procedures.
This family medicine educational experience was not merely a repeat of what is experienced on the traditional major rotations. The family medicine preceptorship provided a setting where students were able to perform several important ambulatory, primary care skills they had not performed during their core curriculum of traditional third-year rotations.
家庭医学教育工作者普遍认为，三年级的家庭医学轮转提供了独特的临床学习体验，但支持这一观点的研究有限。本研究确定了三年级医学生仅在社区家庭医学导师指导期间所执行的临床技能，即便家庭医学轮转是在所有其他必修临床实习之后进行。
在6个学年（1990 - 1996年）期间，87名三年级学生完成了家庭医学导师指导作为他们的最后一轮实习，并在完成除家庭医学之外的所有必修临床实习后，以及在家庭医学导师指导结束后，对他们在80项临床活动（预防保健、临床问题管理和操作）中的体验进行了评分。评分衡量这些活动是在家庭医学轮转期间出现、仅在其他轮转期间出现，还是在两者中都出现。
超过50%的学生在执行五项预防技能（青少年、青年、中年或老年人的健康维护以及体重控制咨询）时，仅在家庭医学导师指导期间获得了相关经验。大多数学生仅在家庭医学导师指导期间独特地积极处理了六个临床问题（急性拉伤和扭伤、腰痛、鼻窦炎、链球菌性咽喉炎、急性支气管炎和骨关节炎）。导师指导提供的执行操作的独特机会很少。
这种家庭医学教育体验不仅仅是传统主要轮转中所经历内容的重复。家庭医学导师指导提供了一个环境，让学生能够执行他们在传统三年级轮转的核心课程中未曾执行过的几项重要的门诊初级保健技能。
