Medical student competence in eliciting a history for "chronic fatigue".
Medical student competence in eliciting a history for "chronic fatigue".
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医学生获取“慢性疲劳”病史的能力。
DOI：
10.1007/s11325-001-0123-4
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Strohl,KP
中科院分区：
文献类型：
--
作者：
Papp,KK;Erokwu,B;Decker,M;Strohl,KP
目的：我们报告了一项观察性研究，研究医学生在复杂病史中的能力，其中睡眠障碍是几种可能的情况之一。方法：观察学生从一个模拟的病人，其主要抱怨是“我累了。我什么都做不了。”九组学生（n = 360）完成内科核心见习的三个考官之一进行了评估。学生们在统一的行为检查表上的每一项都得到了全部、部分或没有学分，其中包括与慢性疲劳相关的常见医学和精神疾病的提示。结果：观察到的平均值最低的项目有关的睡眠行为和头部创伤。不到一半的学生询问了这个人是否有夜间入睡困难，睡眠呼吸暂停的家族史以及午睡的频率和时间。相比之下，大多数学生询问心脏病，代谢紊乱，使用非法药物，饮酒和服用药物。考试者占分数差异的一个重要来源，但站之间的歧视，以客观结构化临床考试（OSCE）的整体测量的顶部和底部的学生。在实习地点、初级保健与传统轨道学生、一年中的时间或性别的基础上，没有观察到统计学上的显著差异。结论：大多数学生没有充分涵盖与睡眠相关的问题，而不是其他相关的疾病时，采取了重点的历史慢性疲劳。
Purpose: We report an observational study of medical students’ abilities in taking a complex history for which sleep disorders is one of several possible conditions. Methods: Students are observed taking a focused history from a simulated patient whose chief complaint is “I am tired. I cannot get anything done.” Nine groups of students (n = 360) completing the internal medicine core-clerkship were evaluated by one of three examiners. Students received full, partial, or no credit for each item on a uniform behavioral checklist, which included prompts for common medical and psychiatric disorders associated with chronic fatigue. Results: Observed means were lowest for items pertaining to sleep behaviors and head trauma. Fewer than half of the students inquired about whether or not the person had difficulty falling asleep at night, family history of sleep apnea, and frequency and length of naps. In contrast, the majority of students inquired about heart disease, metabolic disorders, the use of illicit drugs, alcohol consumption, and the taking of medications. Examiners accounted for a significant source of variance in scores; yet the station discriminated among top and bottom students as measured by the Objective Structured Clinical Examination (OSCE) overall. No statistically significant differences were observed on the basis of clerkship site, primary care versus traditional-track students, time of year, or gender. Conclusion: A majority of students do not adequately cover issues relevant to sleep in contrast to other associated disorders when taking a focused history for chronic fatigue.