Kaplan K M, Masters P A, Leong S L, Wallen B A, Lederer S E, Hawkins A H, Jones R L
Pennsylvania State University College of Medicine, Hershey, USA.
Acad Med. 1999 Jan;74(1 Suppl):S67-9. doi: 10.1097/00001888-199901001-00034.
With funding from The Robert Wood Johnson Foundation's Generalist Physician Initiative, the Pennsylvania State University College of Medicine created a community-based primary care clerkship in general pediatrics, general internal medicine, and family and community medicine, in which third-year students spend a month in a small town, rural area, or urban underserved medical community. In addition to linking students with preceptors who would teach the clinical skills essential to primary care practice, the medical school set out to teach and to evaluate knowledge, attitudes, and behaviors unique to primary care. This paper describes the three-part teaching tool/evaluation developed to address (1) a student's recognition of the characteristics of primary care (learning objectives assignment), (2) a student's ability to appreciate the multiple nonmedical factors influencing a patient's health and experience of illness (family project), and (3) a student's ability to solve clinical problems (clinical reasoning examination). The authors describe how these evaluation methods are linked with the clerkship's goals and objectives and how they yield a richer portrait of the student's performance than the traditional preceptor's evaluation alone can provide. They also discuss the relationship between students' performances on the primary care clerkship and their performances in other clinical clerkships. Similar clinical experiences in primary care should focus on features unique to primary care medicine in both teaching and evaluation.
在罗伯特·伍德·约翰逊基金会全科医生倡议项目的资助下,宾夕法尼亚州立大学医学院在普通儿科学、普通内科学以及家庭与社区医学领域设立了一个基于社区的初级保健实习项目,三年级学生要在小镇、农村地区或城市医疗服务欠缺的社区度过一个月。除了让学生与能够教授初级保健实践必备临床技能的带教老师建立联系外,医学院还着手教授和评估初级保健特有的知识、态度和行为。本文介绍了为解决以下三个方面而开发的教学工具/评估方法:(1)学生对初级保健特点的认识(学习目标任务),(2)学生理解影响患者健康和患病体验的多种非医学因素的能力(家庭项目),以及(3)学生解决临床问题的能力(临床推理考试)。作者描述了这些评估方法如何与实习项目的目标相联系,以及它们如何能比传统的带教老师单独评估更全面地展现学生的表现。他们还讨论了学生在初级保健实习中的表现与他们在其他临床实习中的表现之间的关系。在教学和评估中,初级保健方面类似的临床经验应注重初级保健医学特有的特征。