目的 以认知学徒制理论为基础,探讨不同类型医院实习医学生分散实习模式下对所在医院实习教学质量的认知状况,为保证和提高教学质量同质化提供参考。方法 选取某医学院校在14家医院进行临床实习的2012级临床医学专业251名学生为研究对象,采用自编问卷对其就所在实习医院的教学质量进行调查。结果 医学生就临床实习与其临床思维和能力、人文素质、沟通能力、团队精神、对患者责任感等5个变量的自我认知的结果显示,两两变量之间均具有显著相关关系。在执行实习大纲和带教方面,直属附属医院实习医学生的评价优于非直属附属医院实习医学生的评价。大部分二级学科对实习大纲的执行情况较好,但不同学科之间存在一定差异且具有统计学意义(t=-2.083,P=0.040),直属附属医院二级学科执行情况优于非直属附属医院。带教教师有效反馈对提高实习医学生的工作能力具有较为明显的正向线性关系。结论 不同类型医院分散实习模式下医学生的临床能力可以得到连带性提升。不同类型医院在实习大纲执行的周密性和细致度上存在差异,带教教师的深度有效反馈和对学生的关怀有助于医学生适应临床实习与提高临床能力,医学院校需要更多地关注和加强对非直属附属医院的实习指导,促进分散实习模式下教学质量的同质化。
Objective Based on the theory of cognitive apprenticeship, to explore the cognitive status of medical students in different types of hospitals in order to provide reference for ensuring and improving the quality of teaching. Methods A total of 251 medical students from grade 2012 who experienced clinical intern practice in 14 hospitals were selected as the research objects, and their training outcomes in teaching hospital was investigated by self-designed questionnaire. Results There was a significant correlation between the internship activities of medical students and their clinical capacity, humanistic quality, communication skill, team spirit and sense of responsibility for patients. Most of the disciplines have run a good implementation of the internship program, but there are significant differences between disciplines (t=-2.083, P=0.040). The implementation of affiliated hospital is better than that of the non-affiliated hospital. There is a positive linear relationship between the effective feedback from teachers and the improvement of students' capacity. Conclusions Under the dispersed pattern clinical internship model, the clinical ability of medical students can also be improved. For different kinds of teaching hospitals, there are homogeneity differences in the clinical intern implementation. The detailed feedbacks and concerns of teachers help medical students to adapt to clinical internship. Medical colleges need to strengthen the practice guidance of non-affiliated hospitals to promote the homogeneity of teaching quality.
[1] Stalmeijer RE, Dolmans DH, Wolfhagen IH, et al.Cognitive apprenticeship in clinical practice: can it stimulate learning in the opinion of students?[J]. Adv Health Sci Educ,2009,14(4):535-546.DOI:10.1007/s10459-008-9136-0.
[2] Elzubeir MA,Rizk DE. Identifying characteristics that students, interns and residents look for in their role models[J].Medical Education,2010,35 (3):272-277.DOI:10.1046/j.1365-2923.2001.00870.x.
[3] Beck J, Chretien K, Kind T. Professional identity development through service learning: a qualitative study of first-year medical students volunteering at a medical specialty camp[J].Clin Pediatr,2015,54(13): 1276-1282.DOI:10.1177/0009922815571108.
[4] Andersen DK. How can educators use simulation applications to teach and assess surgical judgment?[J].Academic Medicine,2012,87(7):934-941.DOI:10.1097/acm.0b013e3182583248.
[5] Alhaqwi AI, Kuntze J, van der Molen HT. Development of the clinical learning evaluation questionnaire for undergraduate clinical education: factor structure, validity, and reliability study[J].BMC Med Educ,2014,14:44.DOI:10.1186/1472-6920-14-44.
[6] Pololi L, Price J. Validation and use of an instrument to measure the learning environment as perceived by medical students[J].Teach Learn Med,2000,12(4): 201-207.DOI:10.1207/S15328015TLM1204_7.
[7] Levey RE. Sources of stress for residents and recommendations for programs to assist them[J].Acad Med,2001,76(2):142-150.DOI:10.1097/00001888-200102000-00010.
[8] Burgess A, Goulston K, Oates K. Role modelling of clinical tutors: a focus group study among medical students[J].BMC Med Educ,2015,15:17.DOI:10.1186/s12909-015-0303-8.
[9] Nothelle SK, Christmas C, Hanyok LA. First-year internal medicine residents' reflections on nonmedical home visits to high-risk patients[J].Teach Learn Med,2018,30(1):95-102.DOI:10.1080/10401334.2017.1387552.
