Carney P A, Bar-on M E, Grayson M S, Klein M, Cochran N, Eliassen M S, Gambert S R, Gupta K L, Labrecque M C, Munson P J, Nierenberg D W, O'Donnell J F, Whitehurst-Cook M, Willett R M
Dartmouth Medical School, Hanover, New Hampshire 03755, USA.
Acad Med. 1999 Jan;74(1 Suppl):S59-66. doi: 10.1097/00001888-199901000-00033.
With funding from The Robert Wood Johnson Foundation's Generalist Physician Initiative, Dartmouth Medical School (DMS), New York Medical College (NYMC), and Virginia Commonwealth University School of Medicine (VCU-SOM) adopted early community-based training models for longitudinal clinical experiences. These schools developed different evaluation strategies to assess these models. This paper describes each program, the method used to evaluate an aspect of the program, lessons learned about early clinical teaching and learning, and challenges encountered. Each program used cross-sectional evaluation, and the analysis methods included descriptive statistics, chi-square, t-tests, analysis of variance, and generalized linear models. Dartmouth determined that the type of preceptor does not greatly influence the development of clinical skills, although case-specific differences were discovered. NYMC learned that students taught clinical skills in community-based settings performed as well as or better than their peers who received early patient experience on hospital wards. Virginia Commonwealth discovered that community experiences contributed positively to students' education, critical thinking, and problem-solving skills. Students value early clinical experiences and make important achievements in clinical skills and knowledge development, although logistic challenges exist in conducting these courses. Evaluations are critical to ensure competency, and faculty development must be linked to the evaluation process.
在罗伯特·伍德·约翰逊基金会全科医生倡议项目的资助下，达特茅斯医学院（DMS）、纽约医学院（NYMC）和弗吉尼亚联邦大学医学院（VCU - SOM）采用了早期基于社区的培训模式来开展纵向临床实习。这些学校制定了不同的评估策略来评估这些模式。本文描述了每个项目、用于评估项目某一方面的方法、在早期临床教学中学到的经验教训以及遇到的挑战。每个项目都采用了横断面评估，分析方法包括描述性统计、卡方检验、t检验、方差分析和广义线性模型。达特茅斯发现，带教老师的类型对临床技能的发展影响不大，不过发现了因具体病例而异的情况。纽约医学院了解到，在社区环境中学习临床技能的学生表现与那些在医院病房较早接触患者的同龄人相当或更好。弗吉尼亚联邦大学发现，社区实习对学生的教育、批判性思维和解决问题的能力有积极贡献。学生重视早期临床实习，并在临床技能和知识发展方面取得了重要成果，尽管开展这些课程存在后勤保障方面的挑战。评估对于确保能力至关重要，教师发展必须与评估过程相联系。
