MD-PhD학생을 임상 실습에 대비하여 준비시키기 : PhD과정과 MD과정의 접점에서.

(2차 출처 : http://meandmyresearch.blogspot.kr/2012/09/how-to-succeed-as-phd-student.html

1차 출처 : http://matt.might.net/articles/phd-school-in-pictures/)

의과대학에서는 인문학과 자연과학을 전공한 전임상(preclinical) 과정에 있는 학생들에게 본과3학년과 4학년 때의 임상 환경에 적응할 수 있도록 하기 위해서 환자들과의 상호작용하는 법을 가르치는 것에 많은 자원을 투자한다. 

Medical schools devote substantial resources to training preclinical students in the art and science of interacting with and evaluating patients so that students are prepared to work in the clinical environment during their third and fourth years

그러나 이러한 노력에도 불구하고 많은 의과대학 학생들은 임상 실습(full-time clinical)에 대한 긴장감이 높다.

Despite these efforts, many medical students are anxious about the transition to full-time clinical efforts.1–7

이러한 차이는 physician-scientist(의사 과학자)를 양성하는 과정에서 특히 두드러지는데, 왜냐하면 이 과정(MD-PhD)에서 학생들은 의과대학 기간 중 '고립된(siloed)' 대학원 기간을 보내게 되기 때문이다.

This gap in clinical exposure is emblematic of most training programs for physician–scientists, in which the students tend to move between the “siloed” domains of medical school and graduate school training

그 결과로, 이들은, 특히 MD-PhD 학생들은, 상당한 혼란을 겪고 자신들의 임상 술기에 대한 자신감을 잃어버리게 된다.

As a result, trainees, especially MD-PhD students, can experience confusion (“living in different worlds”) and lose confidence with respect to their clinical skills.

우리는 이러한 것에 관심을 가지게 되었다. UCSD에서 우리 학생들 중 다수가 저자 중 한명 (C.G.)에게 임상실습으로 들어가기 전에 환자를 보는 것과 관련한 기본적 스킬들을 복습하기 위해 찾아온다.

We became interested in this transition period on the basis of our experiences interacting with MD-PhD students at the University of California, San Diego (UCSD). Our students routinely approached one of the authors (C.G.), asking to attend his clinic to brush up on basic patient-care-related skills immediately before beginning their clinical rotations.

이 commentary에서 우리는 우리의 경험을 바탕으로 MD-PhD 학생들의 이행기(transition)문제에 대해 이야기해보고자 한다. 첫 번째로 MD-only 학생과 MD-PhD 학생의 경험의 차이를 논의하고, 그리고 나서 이 문제에 대해서 어떻게 접근했는지 밝힌 후, 제언으로 마무리짓고자 한다.

In this commentary, we draw on our experience identifying and addressing this transition for MD-PhD students at our own institution to call attention to this critical issue. First, we discuss the difference between MD-only students’ and MD-PhD students’ experiences with respect to the transition to clinical training. We then describe how we have approached this problem and close with recommendations for how others may wish to address these same issues

대부분의 미국 의과대학에는 MD학생들이 전임상 과정에서 임상 과정으로 들어가는 과정을 지원하는 프로그램이 있다. 주로 임상 실습을 시작하기 직전 1주일 정도의 기간이 된다.

Most U.S. medical schools offer programs to assist MD students as they transition from preclinical to clinical training.8–13 These efforts typically last about one week and occur immediately before the start of clinical rotations

일련의 교육적 수단을 동원하게 된다

임무와 관련된 것(노트 작성, 구두 발표), 관계와 관련된 것(팀에서 학생의 역할), 문화, 환자관리 세팅에서 지켜야 할 것들.

An array of educational modalities are used, focusing on the tasks (e.g., note writing, oral presentations), relationships (e.g., the student’s role on a patient care team), culture, and rules that govern patient care settings.13

그러나 단기적 혹은 장기적 관점에서 어떤 것이 가장 좋은지, 혹은 이런 방식이 효과적인지에 대한 데이터는 없다.

However, no data identify which aspects are most useful or whether these preparatory efforts are successful in either the short or long run

우리가 생각하기에, 기존의 방법들은 복합학위(dual-degree) 과정에 있는 학생들을 지원하기에 충분하지 않았기에 우리는 Reimmersion Program(RP)라는 코스를 개발하였다.

It was our opinion, supported by the views of transitioning UCSD MD-PhD students, that existing programs were not sufficient to address the deficits and concerns of dual-degree trainees. We thus developed a concise course of study, a reimmersion program (RP), that focused on skills related to typical patient encounters.

RP는 MD-PhD 학생들이 임상 훈련에 대비하는 과정이며, 22시간짜리이고 6주간 일주일에 하루(반일)씩 이뤄진다.

The RP requires 22 hours of effort from MD-PhD students preparing to transition to clinical training, and it occurs one halfday per week across a six-week period. 

신체검진 기술을 리뷰하는 시간으로 시작되고, 남은 시간은 임상 세팅에서 환자, 교수와 같이 진행한다.

지난 4년간 37명이 코스에 참여했다.

It begins with a physical exam skills review session

The remaining RP activities take place with patients and faculty in clinical settings.

Over the past four years, 37 students have participated in the RP

MD-PhD 학생은 MD-only학생들보다 종합 점수에서 더 낮았고, station별로 분석했을 때 심혈관계와 호흡기계 시험에서 낮았다. RP가 마무리되는 시점에서 95%의 MD-PhD학생들은 이 시간이 의미있었고, 후배들에게도 추천하고 싶다고 했다.

We found that the MD-PhD trainees had significantly lower overall scores (P = .01) than their MD-only counterparts. In addition, station-by-station comparison revealed that performance on the cardiovascular and pulmonary exams was lower (P = .05) for MD-PhD trainees than for MD-only students. At the conclusion of the RP, 95% of MD-PhD students reported that these efforts were a good use of their time, and all recommended that it be offered to future students.

우리가 RP를 개발하기 위해서 들인 노력은 full-time 임상 수련을 이제 막 시작하려고 하는 MD-PhD 학생들의 준비를 돕는 것에 대한 insight를 제공한다.

Our efforts in developing and initiating the RP provide insights regarding the perceived and actual levels of preparedness of MD-PhD students who are on the cusp of full-time clinical training

이 학생들의 '준비되지 않음'에 대한 감정은 임상 실습을 앞두고 높은 수준의 불안감으로 나타난다.

Their feeling of being unprepared was manifested by high levels of anxiety regarding upcoming clinical rotations.

이러한 이행 과정이 복합학위과정에 어쩔 수 없이 따라오는 것이지만, 우리가 보기에는 이 이행과정을 최대한 부드럽게 만들기 위한 충분한 노력을 기울인 적은 없었다고 생각한다. 이행과정이 더 어려울수록 "죽음의 계곡"은 더 깊어질 것이다.

Although such transitions are intrinsic to dual-degree training programs, we believe that not enough has been done to make them as smooth as possible. Difficult transitions, in turn, contribute to the growing gap between the clinical and research enterprises, further widening the “valley of death” that separates bench research from clinical application.17

우리는 우리의 경험에서 얻을 수 있는 것처럼, 이러한 문제가 해결될 수 있다고 생각한다.

We believe, and our experience suggests, that these deficits can be corrected

아직 이상적인 RP가 완성된 것은 아니다.

In spite of these efforts and beliefs, an optimal RP has not been defined

RP를 만들고 정교하게 다듬는 것은 비교적 많지 않은 시간, 노력, 자원으로도 가능하고, 그것은 지금의 의사-과학자 양성 과정의 이해와 부드럽게 융합될 수 있을 것이다.

Establishing and refining RPs can be accomplished with a relatively modest amount of time, effort, and resources, and doing so meshes nicely with the current interest in reevaluating the physician–scientist training process.17–28

(출처 : http://www.darkdaily.com/supreme-court-agrees-to-consider-myriad-case-involving-human-gene-patents-12113#axzz2WfF7At3j)

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Acad Med. 2013 Jun;88(6):745-7. doi: 10.1097/ACM.0b013e31828ffeeb.

Preparing MD-PhD Students for Clinical Rotations: Navigating the Interface Between PhD and MD Training.

Goldberg C, Insel PA.

Source

Dr. Goldberg is professor of medicine, University of California, San Diego School of Medicine, La Jolla, California, and staff physician, San Diego VA Healthcare System, San Diego, California. Dr. Insel is director, Medical Scientist Training Program, vice chair/distinguished professor of pharmacology, and distinguished professor of medicine, University of California, San Diego School of Medicine, La Jolla, California.

Abstract

Many aspects of MD-PhD training are not optimally designed to prepare students for their future roles as translational clinician-scientists. The transition between PhD research efforts and clinical rotations is one hurdle that must be overcome. MD-PhD students have deficits in clinical skills compared with those of their MD-only colleagues at the time of this transition. Reimmersion programs (RPs) targeted to MD-PhD students have the potential to help them navigate this transition.The authors draw on their experience creating and implementing an RP that incorporates multiple types of activities (clinical exam review, objective structured clinical examination, and supervised practice in patient care settings) designed to enhance the participants' skills and readiness for clinical efforts. On the basis of this experience, they note that MD-PhD students' time away from the clinical environment negatively affects their clinical skills, causing them to feel underprepared for clinical rotations. The authors argue that participation in an RP can help students feel more comfortable speaking with and examining patients and decrease their anxiety regarding clinical encounters. The authors propose that RPs can have positive outcomes for improving the transition from PhD to clinical MD training in dual-degree programs. Identifying and addressing this and other transitions need to be considered to improve the educational experience of MD-PhD students.