임상실습 책임교수는 학생들이 임상실습에 준비가 되었다고 생각할까? (Acad Med, 2004)

임상실습 책임교수는 학생들이 임상실습에 준비가 되었다고 생각할까? (Acad Med, 2004)

Do Clerkship Directors Think Medical Students Are Prepared for the Clerkship Years?

Donna M. Windish, MD, Paul M. Paulman, MD, Allan H. Goroll, MD, and Eric B. Bass, MD, MPH

지난 몇 년 동안 미국 조직은 의료 교육의 모든 단계에서 커리큘럼 개혁의 필요성을 인식했습니다. 의학교육자가 이러한 많은 변화를 뒷받침하지만, 실행은 도전 과제가 될 수 있습니다 .12

Over the past several years, U.S. organizations have recognized the need for curricular reform in all stages of medical training. Although medical educators support many of these changes,11 implementation can be a challenge.12

핵심 임상실습에서 성공적인 학습을 위한 사전 학습 준비의 중요성을 균등하게 인식했습니다. 관심을 끌기 위해 몇 가지 역량이 선정되었습니다.

• 의사 소통 능력,

• 면담 / 신체 검사,

• 임상 역학 및 확률 론적 사고,

• 전문 직업 의식,

• 진료 시스템 및

• 생명주기 단계에 대한 관심 15

collaborators have uniformly recognized the importance of preclerkship preparation to successful student learning in the core clerkships. Several competencies have been singled out for attention: 

• communication skills, 

• interviewing/physical examination, 

• clinical epidemiology and probabilistic thinking, 

• professionalism, 

• systems of care, and 

• attention to life-cycle stage.15 

문제는이 6 개 영역에서 전임상 역량의 적절한 수준과 핵심 직무에 대한 준비의 적절성입니다. 미국 의과 대학의 커리큘럼 계획을 알리기 위해 핵심 직책 감독자에 대한 전국 설문 조사를 실시하여 6 가지 핵심 역량에 대한 적절한 준비 과정 및 학생 준비 상태에 대한 의견을 결정했습니다.

At issue is the appropriate level of preclerkship competence in these six areas and the adequacy of preparation for the core clerkships. To help inform curriculum planning at U.S. medical schools, we conducted a national survey of core clerkship directors to determine their views on the appropriate level of clerkship preparation and on the current state of student preparedness with regard to the six core competencies.

METHOD

Study Design and Target Population

We conducted a national cross-sectional survey of clerkship directors at 32 U.S. medical schools.

Sampling Strategy

Given the target population, we decided on a selection process that would ensure a broad representation of medical schools. We first stratified all medical schools by awards received from the National Institutes of Health (NIH) for the 2001 federal fiscal year.16 

From this list, schools were divided into two groups: 

• those in the top half of research funding dollars and 

• those in the bottom half of research funding dollars. 

Schools were then separated into four geographic regions in the United States: 

• Northeast, 

• Southeast, 

• Midwest, and 

• West/Southwest. 

Using a random numbers table, we chose eight schools from each region (four schools with top 50% NIHfunding, and four schools with bottom 50% NIH funding), giving a total of 32 schools.

Survey Instrument

In 2000, the U.S. Health Resources and Services Administration funded the Family Medicine Curriculum Resource Project to help educators develop a resource document to address all four years of family medicine education, medicine including the core family clerkship. As part of the project, a Preclerkship Collaborative Workgroup (comprised of educators in pediatrics, internal medicine and family medicine) identified 

의과 대학의 첫 2 년 동안 우선 순위가 높은 6 가지 역량 :

six competencies as high priorities in the first two years of medical school: 

• 의사 소통 능력,

• 인터뷰 / 신체 검사,

• 임상 역학 및 확률론적 사고,

• 전문 직업 의식,

• Systems of care를 이해하고

• 환자의 라이프 사이클 단계를 이해합니다.

• communication skills, 

• interviewing/physical examination, 

• clinical epidemiology and probabilistic thinking, 

• professionalism, 

• understanding systems of care, and 

• understanding a patient’s life-cycle stage.

Survey Administration

We mailed questionnaires to each clerkship director in October 2002. Reminder letters were sent four weeks later. A final mailing was sent at eight weeks to those who did not respond to the first two mailings.

Data Analysis

We calculated and displayed various characteristics of the respondents by percentage. For each competency, we also calculated the percentage of respondents reporting that students need at least intermediate ability, and the percentage reporting that students are less prepared than necessary.

결과

RESULTS

Of the 190 clerkship directors surveyed, 140 (74%) returned the questionnaire.The response rate varied somewhat by clerkship type and geographic location(see Table 1).

필요한 역량 및 준비 상태

Level of Ability Required and Preparation Needed in Each Competency

대부분의 임상실습 감독은 학생들이 첫 번째 핵심 임상실습에 들어가기 전에 여섯 가지 역량 중 다섯 가지 역량역량을 intermediate 수준으로 갖춰야 한다고 말했다(그림 1 참조). 조사원 사무원의 95 % 이상이 학생들이 의사 소통 기술 및 전문성에서 중급에서 고급 수준의 능력이 필요하다고 느꼈습니다. 상대적으로 73 %는 학생들이 보육 시스템을 이해하는 데 필요한 최소한의 능력이없는 것으로 나타났습니다.

The majority of clerkship directors re-ported that students need at least intermediate ability in five of six competencies before entering their first core clerkship (see Figure 1). Over 95% of the clerkship directors surveyed felt students need intermediate to advanced level of ability in communication skills and professionalism. Comparatively, 73% felt that students need minimal or no ability in understanding systems of care.

Many clerkship directors indicated that their clerkship provides formal training in at least one of these six competencies because they believe students do not receive as much instruction as necessary in the preclerkship curriculum. 

Sixty percent of respondents stated they offer training in inter-viewing/physical examination, 35% in communications skills, 32% in epidemiology/probabilistic professionalism, thinking, 27% in 27% in life-cycle stages, and 14% in systems of care. 

하위 그룹 분석

Subgroup Analyses

각 질문에 대한 답변은 사무원 및 각 기관의 특성에 따라 재검토되었습니다. 비 외과 1 차 의료 분야 (가정 의학, 내과 및 소아과)의 사무직 직능 검사자의 견해는 외과 또는 비 주치의 분야 (산부인과, 산부인과, 수술 및 정신과)의 그것들과 비교되었다 (표 2 참조).

We reexamined responses to each question based on characteristics of the clerkship directors and their individual institutions. The views of clerkship di-rectors in nonsurgical primary care disciplines (family medicine, internal medicine, and pediatrics) were compared to those in the surgical or non–primarycare fields (obstetrics/gynecology, surgery, and psychiatry) (see Table 2).

전임상 교과 과정에서 더 많은 관심을 필요로하는 가장 중요한 역량을 확인하라는 질문에 32 %는 인터뷰 / 신체 검사, 21 % 의사 소통 기술, 16 % 전문성, 16 % 역학 / 확률 론적 사고, 8 % 이해 수명주기 단계, 6 % 이해 케어 시스템, 2 %는 다른 주제를 나열했습니다.

When asked to identify the most important competency that needs more attention in the preclerkship curriculum, 32%cited interviewing/physical examination, 21% communication skills, 16% professionalism, 16% epidemiology/probabilistic thinking, 8% understanding lifecycle stage, 6% understanding systems of care, and 2% listed other topics.

고찰

DISCUSSION

우리의 연구는 가정 의학 임상실습을 위한 커리큘럼 개선에 초점을 둔 프로젝트를 알리는 데 목적이 있었지만, 다른 일차진료 분야 외에도 모든 임상 분야의 견해에 대한 주목할만한 공감대를 보았습니다.

Although our study was aimed at informing a project focused on improving curricula for family medicine clerkships, we saw a striking consensus of views in all of the clinical disciplines represented, not just in family medicine or the other primary care-oriented disciplines.

하위 집단 들간의 비교의 대부분은 6 가지 역량에 대한 학생들의 예비 학습 훈련에 대한 의견이나 인식에 큰 차이가 없음을 보여 주었다. 의견의 일치도가 높다는 것은 많은 전문 분야의 사무장이 핵심 직무에 대한 의대생 준비와 관련하여 비슷한 견해와 우려를 갖고 있음을 나타냅니다. 즉, 준비가 중요하며 응답자의 거의 절반이 준비가 불충분하다는 점입니다.

the majority of our comparisons between subgroups revealed no significant differences in opinions or perceptions about the preclerkship training of students in the six competencies. The high concordance of opinions indicates that clerkship directors of many specialties share similar views and concerns regarding medical student preparation for the core clerkships, namely that preparation is important and that in the view of nearly half of respondents, preparation is inadequate.

6 가지 역량은 의학 교육의 연속체 전반에 걸쳐 중요하게 인식됩니다. 1999 년에 ACGME는 레지던트들이 훈련이 끝날 때 숙련되어야하는 6 가지 역량을 승인했습니다 .10 

The six competencies are recognized as important throughout the continuum of medical education. In 1999, the ACGME endorsed six competencies that residents should have proficiency in by the end of their training.10 Each of these competencies coincides with areas we assessed:

• communication skills (ACGME: interpersonal and communication skills),

• interviewing/physical examination skills (ACGME: patient care), 

• professionalism (ACGME: professionalism), 

• systems of care (ACGME: systems-based practice), 

• epidemiology/ probabilistic thinking (ACGME: medical knowledge and practice-based learning and improvement), and 

• life-cycle stages (ACGME: patient care).

우리의 결과는 많은 의과 대학의 학생들이 임상실습 기간에 들어가기 전에 충분히 준비되어있지 않을 수 있음을 시사합니다. 1984 년 미국 의사 협회 (Association of American Medical Colleges)의 프로젝트 패널이 의사의 일반 전문 교육과 의학 준비 과정에 관한 보고서를 발표 한 이래로 많은 과학자들이 기초 과학 교육과 임상 교육을 통합하고 문제 중심 학습에 더 많은 관심을 기울여야한다는 요구에 부응 해왔다. 대부분의 교과 과정 변경은 임상 기술과 사회 생활 교육에 대한 종합 과목을 통해 교육 첫 2 년 동안 발생했습니다 .18

Our results suggest that students in many medical schools may receive inadequate preparation before entering the clerkship years. Since the Association of American Medical Colleges’ project panel on the General Professional Education of the Physician and College Preparation for Medicine report in 1984, many schools have responded to the call to integrate basic science teaching and clinical education, and to place a greater focus on problem-based learning. Most curricular changes have occurred in the first two years of training through multidisciplinary courses in clinical skills and sociobehavioral education.18

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Acad Med. 2004 Jan;79(1):56-61.

Do clerkship directors think medical students are prepared for the clerkship years?

Windish DM1, Paulman PM, Goroll AH, Bass EB.

Author information

1

Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. dwindish@jhmi.edu

Abstract

PURPOSE:

Educators have begun to question whether medical students are adequately prepared for the core clerkships. Inadequate preclerkship preparation may hinder learning and may be predictive of future achievement. This study assessed and compared the views of clerkship directors regarding student preparation for the core clinical clerkships in six key competencies.

METHOD:

In 2002, a national survey was conducted of 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology, and psychiatry from 32 U.S. medical schools. Clerkship directors were asked to report their views on the appropriate level of student preparation needed to begin the core clinical clerkships (none, minimal, intermediate, advanced), and the adequacy of that preparation (ranging from "much less" to "much more than necessary") in six key clinical competencies.

RESULTS:

A total of 140 clerkship directors responded (74%). The majority reported that students need at least intermediate ability in five of six competencies: communication (96%), professionalism (96%), interviewing/physical examination (78%), life-cycle stages (57%), epidemiology/probabilistic thinking (56%), and systems of care (27%). Thirty to fifty percent of clerkship directors felt students are less prepared than necessary in the six competencies. Views were similar across all specialties and generally did not differ by other clerkship director characteristics.

CONCLUSIONS:

Almost half of clerkship directors were concerned that students do not receive adequate preparation in key competencies before starting the core clinical clerkships. Many medical schools may need to give more attention to the preclerkship preparation of students in these high-priority areas.

PMID:

 

14690998

[Indexed for MEDLINE]