Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship.

IF 5.3 2区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Academic Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-01 DOI:10.1097/ACM.0000000000005747
Capri P Alex, H Barrett Fromme, Larrie Greenberg, Michael S Ryan, Sarah Gustafson, Maya K Neeley, Shaughn Nunez, Molly E Rideout, Jessica VanNostrand, Nicola M Orlov
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引用次数: 0

Abstract

Purpose: Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions.

Method: This multimethod study was performed at 6 U.S.-based institutions from March to October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses.

Results: Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]).

Conclusions: This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.

探索医学生在儿科实习期间的直接观察经验。
目的:直接观察(DO)可以评估临床技能等重要能力。尽管国家要求医学生在每次实习期间都要进行直接观察,但这些观察的频率、时间长度、质量和背景并没有得到很好的确定。本研究考察了多所院校在儿科实习期间获得的实习指导的质量、数量和特点:本研究采用多种方法,于 2022 年 3 月至 10 月在美国 6 所院校进行。在定性研究阶段,作者在儿科实习结束后对三年级医学生进行了焦点小组和/或半结构式访谈。在定量阶段,作者在焦点小组讨论或访谈后使用了内部开发的工具。定性数据采用主题分析法进行分析,定量数据采用匿名调查法进行分析:73名医学生参加了20个焦点小组,71人(97.3%)完成了调查。作者确定了 7 个主题,并将其归纳为关键原则:实习前、实习中和实习后。大多数学生表示,在住院环境中,他们的DO主要由住院医师(62人[87.3%])而非主治医师(6人[8.4%])进行。学员们报告说,主治医师每天都会观察他们的临床推理能力(38 [53.5%])、沟通能力(39 [54.9%])和表达能力(58 [81.7%])。三分之一的学生称他们从未被住院主治医师观察过病史采集(23 [32.4%]),四分之一的学生称他们从未被观察过体格检查(18 [25.4%]):这项研究表明,主治医师对学生在住院环境中执行重要临床技能的评估并不像以前认为的那样频繁。当观察者设定期望值、创造安全的学习环境并跟进可操作的反馈时,医学生会认为这种经历很有价值;然而,目前的DO经历并不理想。因此,有必要为医学生提供高质量、以能力为基础的临床教育,通过培养有能力的医生队伍来直接推动未来的患者护理工作。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Academic Medicine
Academic Medicine 医学-卫生保健
CiteScore
7.80
自引率
9.50%
发文量
982
审稿时长
3-6 weeks
期刊介绍: Academic Medicine, the official peer-reviewed journal of the Association of American Medical Colleges, acts as an international forum for exchanging ideas, information, and strategies to address the significant challenges in academic medicine. The journal covers areas such as research, education, clinical care, community collaboration, and leadership, with a commitment to serving the public interest.
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