学习管理:对研究生医学实习生如何发展管理推理的定性探索
Andrew S Parsons1, Karen Bryan2, Charles Morris3
1Department of Medicine, Division of Hospital Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States.
概括
医疗学员通过实践患者护理和观察来发展管理推理,从刚性到以患者为中心的决策. 教师应该培养自主性和口头表达,以提高这一关键技能.
科学领域:
- 医学教育 医学教育
- 临床推理 临床推理
- 定性研究是指质量研究.
背景情况:
- 管理推理对于患者护理至关重要,但在医学教育中欠发达.
- 了解学员如何学习管理推理对于课程开发至关重要.
研究的目的:
- 探索毕业后的医疗学员在医学院和住院期间如何发展管理推理.
- 识别支持或阻碍管理推理发展的因素.
主要方法:
- 使用28名住院者 (研究生2至4年) 的重点小组进行定性研究,来自内科,儿科,家庭医学和医学-儿科.
- 利用双重过程理论和定位认知理论.
- 采用反射的主题分析来确定关键主题.
主要成果:
- 出现了四个主题:学习格式,支持因素,障碍和发展轨迹.
- 实习生通过体验性活动 (患者管理,观察) 和同行/顾问互动来学习.
- 支持因素包括口头表达,自主,案例变化和反思;障碍因素包括层次结构和缺乏连续性.
结论:
- 实习生从依赖指导方针的管理推理发展到以患者为中心的管理推理.
- 临床环境应该促进逐渐的自主性和推理的口头化.
- 解决障碍和利用支持因素是开发未来临床医生有效管理推理的关键.
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