Direct observation of students during clerkship rotations: A multilayer descriptive study
Direct observation of students during clerkship rotations: A multilayer descriptive study
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DOI：
10.1097/00001888-200403000-00017
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发表时间：
2004-03-01
影响因子：
7.4
通讯作者：
Wilson, WG
中科院分区：
文献类型：
--
作者：
Howley, LD;Wilson, WG
目的.确定学生报告他们在实习期间进行体检和记录历史时被观察的频率。从1999年到2001年，弗吉尼亚大学医学院的397名学生在他们的第三年结束时被要求报告他们被住院医生或教职员工观察的次数，白色记录历史并进行六次旋转的身体检查。345名学生（87%）返回的调查工具，其中，322（81%）返回的仪器与完整的信息。平均而言，大多数人报告说，他们从来没有被观察到的教员，而采取的历史（51%），进行重点体检（54%），或一个完整的体检（81%）。大多数（60%）报告说，他们从来没有被观察到的居民，而进行全面的身体检查。教师的意见发生最频繁，在为期四周的家庭医学轮换，最不频繁，在12周的手术轮换。实习期的长短与报告的观察次数呈负相关，卡方2（5，n = 295）127.85，P <0.000。虽然临床技能的替代评估在医学教育中越来越普遍，但基于直接观察的教师评级仍然很突出。这项研究中的数据反映出，这些观察结果实际上可能很少发生，如果有的话。在实习轮换期间，降低教师和住院医师评级的评价权重可能是必要的。否则，应努力提高这些评级的有效性。
Purpose. To determine how often students report that they are observed while performing physical examinations and taking histories during clerkship rotations.Method. From 1999-2001, 397 students at the University of Virginia School of Medicine were asked at the end of their third year to report the number of times they had been observed by a resident or faculty member, white taking histories and performing physical examinations on six rotations.Results. Three hundred and forty-five students (87%) returned the survey instrument; of these, 322 (81%) returned instruments with complete information. On average, the majority reported that they had never been observed by a faculty member while taking a history (51%), performing a focused physical examination (54%), or a complete physical examination (81%). The majority (60%) reported that they had never been observed by a resident while performing a complete physical examination. Faculty observations occurred most frequently during the four-week family medicine rotation and least frequently during the 12-week surgery rotation. The length of the clerkship rotation was inversely related to the number of reported observations, chi(2) (5, n = 295) 127.85, P < .000.Conclusions. Although alternative assessments of clinical skills are becoming more common in medical education, faculty ratings based on direct observation are still prominent. The data in this study reflect that these observations may actually be occurring quite infrequently, if at all. Decreasing the evaluative weight of faculty and resident ratings during the clerkship rotation may be necessary. Otherwise, efforts should be made to increase the validity of these ratings.