- LIC와 BC 학생 모두 환자를 support하고 care에 대한 정보를 공유하는데 있어서 중요한 역할을 하고 있다고 응답한 데에 반해, LIC학생만이 "doctor role with patients"로서 성장(grow)하는 것에 대한 지속적인 기회가 있었다고 응답했다. LIC학생들은 care system에 높은 수준으로 통합(integration)되고, 교수자 또는 환자와 깊은 관계를 형성함으로써 환자중심care의 역량이 향상되고 더 동기화됨을 느낀다고 하였다.
- 전통적인 BC방식의 임상 교육은 in-patient service team에 일원으로서 학생을 투입하지만, 임상 참여를 encourage하는 측면에서 부족한 점이 많다. 이러한 모델에서는 초보 학습자는 가장자리로 밀려나고(marginalize), 감독하는 staff도 자주 바뀌게 된다. Clerkship의 구조와 학생이 얼마나 integration되었느냐는 clerkship의 만족도와 직결된다. 그러나 학생들은 학습 니즈에 맞지도 않고, 적절한 학습기회도 제공하지 못하는, 그러나 자주 변화하는 service에 대해서 연속적으로 적응해야 한다. 학생들에게 각 과의 문화에 동화되는 것은 어려운 일이고, 바뀌는 세팅에 따라서 배운 것을 적용시키느라(transfer) 애를 먹는다. 심지어 core clerkship의 마지막까지도 학생들은 novice처럼 새롭게 시작하게 된다.
- 이러한 상황은 "supported or guided participation"으로 대변되는 successful workplace learning과 대비된다. (health care provider와 활발하게 상호작용하며, 환자 care에 적극적으로 참여시킴으로써 학습의 기회를 주고, 의도적으로 도전적인 과제를 주는 방식)
- Sample
- We selected participants from the University of California San Francisco (UCSF), the University of South Dakota Sanford School of Medicine (USD) and Harvard Medical School (HMS).
- All three schools have concurrent LICs (at a tertiary hospital for UCSF, and at community sites for USD and HMS) and BCs (at tertiary hospitals and affiliated clinics). Students rank their clerkship preferences; most receive their first choice. Each LIC included 2–6 weeks in an in-patient context during an otherwise predominantly out-patient core clerkship experience.
- Block clerkship students had predominantly in-patient experiences with varying amounts of ambulatory time in discipline-based clerkships, and a single longitudinal clinical experience
- Discussion
- BC 학생들은 스스로를 감독 의사의 바쁜 스케줄로 인해 비는 시간을 채우는 역할로 인지하고 있었고, LIC 학생들은 환자를 위하여 의사와 같은 역할을 한다고 느꼈으며, 그들의 감독의사와 collaborate with 했다고 생각했다. 반면 BC학생들은 스스로를 연말이 되어서는 더 학생과 같은 역할로 묘사했다.
The role of role: learning in longitudinal integrated and traditional block clerkships.
Source
Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA. karen.hauer@ucsf.edu
Abstract
CONTEXT:
Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinalintegrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design.
METHODS:
This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data.
RESULTS:
Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care.
CONCLUSIONS:
Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care.
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