What Training Is Needed in the Fourth Year of Medical School? Views of Residency Program Directors
What Training Is Needed in the Fourth Year of Medical School? Views of Residency Program Directors
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DOI：
10.1097/acm.0b013e3181a82426
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发表时间：
2009-07-01
影响因子：
7.4
通讯作者：
Harper, G. Michael
中科院分区：
文献类型：
--
作者：
Lyss-Lerman, Pamela;Teherani, Arianne;Harper, G. Michael
目的识别实习生的共同困境，确定住院医师项目主任（PD）对医学院第四年应获得的能力的看法，并应用这些信息来制定课程改革和学生建议的目标。方法2007年，对加州大学旧金山分校医学院学生最常见的10个专业选择中的30名PD进行了半结构化访谈，以评估PD对知识、技能和态度的优先考虑。第四年获得。结果实习生普遍存在的问题是缺乏自我反思和提高、组织能力差、专业素养不强、医学知识匮乏。研究生医学教育认证委员会认为患者护理、基于实践的学习和改进、人际和沟通技巧以及专业精神等能力是四年级学生发展的基础。建议的跨专业轮换包括学生未来领域和内科 (IM) 的副实习、IM 亚专科、重症监护以及急诊和门诊医学的轮换。 PD 鼓励尽量减少学生在未来领域花费的额外时间。建议的课程包括强化指导的过渡实习和提高学生医学知识的课程。结论PD 认为第四年在课程中发挥着关键作用。对于第四年的预期能力和共同临床经验达成了共识，这些经验最适合学生为住院医师培训做好准备。这些发现支持利用第四年将学生过渡到医学培训研究生并突出课程创新领域。
PurposeTo identify common struggles of interns, determine residency program directors' (PDs') views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising.MethodIn 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students the University of California, San Francisco, School of Medicine to assess the PDs' priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes.ResultsCommon struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practice-based learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students' development. Rotations recommended across specialties were a subinternship in a student's future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student's future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students' medical knowledge.ConclusionsPDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation.