Phinney A O, Hager W D
University of Connecticut School of Medicine, USA.
Conn Med. 1998 Jun;62(6):337-41.
The recent changes in medical school curricula, brought about by insurance companies, government agencies, and market forces have shifted the focus of patient care from hospital bedside to office or clinic. Classic approaches to the teaching of medical students in the subspecialties have become confused and inadequate. Students' confidence in their own clinical expertise has been hampered by lack of teaching and guidance, and these functions cannot be filled by higher technology. We have completed a successful four year project for fourth year students utilizing a busy practice of cardiology/internal medicine in monthly electives. Among the objectives were to share the real life practice of medicine primarily in an office setting thereby decentralizing patient care and teaching outside of the medical school; to help students gain experience and confidence in the clinical skills of diagnosis and to help them choose "high tech" procedures that are appropriate, and have acceptable cost/benefit ratios; and to recruit an enlightened teaching faculty from practicing physicians who will become medical student advocates, facilitators, and role models, especially for the difficult years of managed care ahead. The elective met with enthusiastic support from all students, whose follow-up letters from residencies confirmed the practical value of the course in clinical skills as well as in choice of appropriate higher technology. Although poorly compensated at present, a few plausible suggestions are offered. If structured and coordinated efficiently this practical experience for students can be a real incentive for continued education, inspiration, and pleasure for the faculty monitor, without compromising his or time or income.
由保险公司、政府机构和市场力量带来的医学院课程近期变化，已将患者护理的重点从医院病床转移至办公室或诊所。医学专科领域中传统的医学生教学方法变得混乱且不足。由于缺乏教学和指导，学生对自身临床专业知识的信心受到了阻碍，而这些功能无法由高科技来填补。我们利用每月一次的心脏病学/内科繁忙门诊，为四年级学生完成了一个为期四年的成功项目。其中的目标包括：主要在门诊环境中分享医学的实际诊疗过程，从而将患者护理和教学分散到医学院之外；帮助学生在诊断临床技能方面获得经验和信心，并帮助他们选择合适且成本效益比合理的“高科技”诊疗程序；从执业医生中招募有见识的教师队伍，这些教师将成为医学生的支持者、促进者和榜样，尤其是应对未来艰难的管理式医疗时代。该选修课程得到了所有学生的热烈支持，他们从住院医师培训发来的后续信件证实了该课程在临床技能以及选择合适的高科技诊疗程序方面的实用价值。尽管目前报酬微薄，但还是提出了一些可行的建议。如果进行有效组织和协调，这种为学生提供的实践经验对于继续教育而言可以是一种真正的激励，对于教师指导者来说可以是一种鼓舞和乐趣，同时又不影响其时间或收入。
