Evaluation of a Direct Observation, Coaching and Assessment Model for the Internal Medicine Clerkship

IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL

Clinical Teacher Pub Date : 2025-04-07 DOI:10.1111/tct.70091

Katherine C. Wrenn, Cancan Zhang, Amy R. Weinstein

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引用次数: 0

Abstract

Background

With a trend towards competency-based assessment in medical education, there is a need for increased direct observation, feedback and coaching of medical students during clinical rotations.

Approach

To increase observation and provide more coaching and feedback, we designed a model in which a faculty coach met with students longitudinally during the internal medicine clerkship. The first session included an observed history and physical (H&P), and the coach and student identified skill areas to focus on in remaining sessions. All sessions included a debrief with feedback.

Evaluation

Students received a survey to rate the amount and quality of observation and feedback received, and we used ordinal logistic regression models to assess the intervention. We conducted thematic analysis to assess what students found most useful. Students in the intervention group reported more direct observation performing the H&P (OR = 9.17, 95% CI [1.86, 70.05], p = 0.01) and found the personalized feedback and increased opportunities to discuss clinical reasoning valuable.

Implications

With a growing need for longitudinal observation of clinical skills to allow for competency-based assessments, at a time in which there is often insufficient continuity between students and supervising physicians, this model helps address needs for increased direct observation, coaching and feedback on skill development over time.

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背景在医学教育中，能力评估已成为一种趋势，因此需要在临床轮转期间增加对医学生的直接观察、反馈和指导。方法为了增加观察并提供更多的指导和反馈，我们设计了一种模式，即在内科实习期间，由一名教师教练与学生进行纵向会面。第一节课包括观察病史和体格检查（H&P），教练和学生共同确定其余课程中需要重点掌握的技能领域。所有课程都包括有反馈的汇报。评估学生接受了一份调查，对观察和反馈的数量和质量进行评分，我们使用了序数逻辑回归模型对干预进行评估。我们进行了主题分析，以评估学生认为最有用的内容。干预组的学生表示在进行 H&P（OR = 9.17，95% CI [1.86，70.05]，p = 0.01）时得到了更多的直接观察，并认为个性化的反馈和更多讨论临床推理的机会很有价值。启示随着对临床技能进行纵向观察以进行能力评估的需求日益增长，而学生与指导医生之间往往缺乏连续性，因此该模式有助于满足对技能发展进行更多直接观察、指导和反馈的需求。

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

Clinical Teacher MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

2.90

自引率

5.60%

发文量

113

期刊介绍： The Clinical Teacher has been designed with the active, practising clinician in mind. It aims to provide a digest of current research, practice and thinking in medical education presented in a readable, stimulating and practical style. The journal includes sections for reviews of the literature relating to clinical teaching bringing authoritative views on the latest thinking about modern teaching. There are also sections on specific teaching approaches, a digest of the latest research published in Medical Education and other teaching journals, reports of initiatives and advances in thinking and practical teaching from around the world, and expert community and discussion on challenging and controversial issues in today"s clinical education.