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Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.
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Objective:To improve the clinical skills of medical students, and explore the implementation plan and effect of diversified laboratory open training.Methods:A total of 808 undergraduate students of clinical medicine in Batch 2015 were selected for diversified laboratory open training in the 5th, 6th and 7th semesters. Multiple reservation methods were adopted including: personal independent network reservation, written reservation, "registered" network reservation; diversified open model: students practice independently, "workshop" special operation training, team make-up lessons; diversified practice modules: basic skills, specialist skills, and comprehensive skills. The results of the questionnaire survey on the two stages of students' diversified laboratory open training and the end of the internship were analyzed; and the Batch 2015 and Batch 2014 graduation skills test scores were compared. SPSS 20.0 software was used for t-test. Results:After the opening of the diversified laboratory: 92.61% (664/717) of the students were satisfied with the open model; 93.58% (671/717) of the students were satisfied with the reservation method; 94.42% (677/717) of the students thought that it could promote learning motivation; 97.35% (698/717) of the students thought that it could stimulate learning interest; 96.51% (692/717) of the students thought that it could help knowledge and skills grasp. After the internship and the return to the school, the questionnaire showed that 98.02% (741/756) of the students thought it could improve clinical skills; 92.33% (698/756) of the students thought it could cultivate clinical thinking; 95.63% (723/756) of the students thought it could enhance self-confidence in the internship; 94.18% (712/756) of the students thought it could increase a sense of professional belonging. The students' graduation skills (90.33±5.59) and single skill exam scores of Batch 2015 were better than Batch 2014 (82.22±7.19), with a statistically significant difference ( P<0.001). Conclusion:The opening of diversified laboratory could stimulate the interest and motivation of learning, help to improve clinical skills and clinical thinking, and enhance confidence in internship and sense of professional belonging.
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This study mainly introduces the exploration of the construction and management of multi-level medical training platform in clinical skills center of the Affiliated Hospital of Yangzhou University. Through the construction of a multi-level clinical skills training platform, a reasonable hierarchical training program is formulated by taking the clinical basic skills training platform and the clinical specialist skills training platform as the basic core teaching content. This program adopts various ways to improve the teaching quality, effectively promote students' ability of clinical practice step by step, meet the needs of different levels of medical personnel in different stages, scientifically and effectively cultivate the high-quality medical personals, and give full play to the role of hospital clinical skills center in medical education, which lays a good foundation for the continuous improvement of teaching quality in hospitals.
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Objective:To explore the research hotspots and development trends of the transformation of virtual skill training to practical clinical ability in current medical simulation education, and to conduct visual bibliometric analysis.Methods:Taking 783 pieces of literature related to the transformation of simulation skill training to clinical competence collected from the Web of Science core collection database from 2006 to 2020 as data sources, CiteSpace V was used for visualization processing and analysis, so as to reveal the transformation effect and future research direction.Results:The number of published papers and citations increased exponentially with each year. The United States and Canada were the main research forces, the University of Toronto Medical Center contributed the largest number of research, and Professor McGaghie of Northwestern University was the author with the most published articles. According to the literature co-citation cluster analysis, it is found that the transformation of simulation skill training includes both operation and non-operation skills. High-frequency cited references reflect the knowledge base of this field and research to a certain extent. Research frontiers include the improvement of virtual reality simulators, clinical outcomes of simulated training in pediatrics, nursing, and emergency disciplines, and the design of randomized controlled clinical trials.Conclusion:The research on the clinical effect verification of simulation skill training is developing rapidly in the world. The research on medical skills' transformation represented by minimal invasive surgery such as endoscopy is a hot topic. Non-operational skills including communication skills, teamwork, pediatric emergency skills, and virtual reality technology simulation effects are the research frontiers. The number of researches on the effect of simulation training is small and the effect is unclear. In the future, more randomized controlled studies are still needed to determine the effectiveness of the transformation of simulation training to clinical competence.
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With the course of Clinical Skill Training as an example, this article integrates hierarchical teaching and peer teaching, adopts the problem-based learning (PBL) teaching model and famous traditional Chinese medicine (TCM) teaching clinics, connects the assessment criteria for standardized residency training, and pays attention to cultivating a reasonable teacher team, so as to improve the overall teaching quality of the course and the enthusiasm for the course among students. The application of the teacher inheritance model combined with case-based learning (CBL) teaching can help medical students to learn and inherit the clinical experience and skills, communication methods, and academic ideas of famous old TCM doctors and inherit and carry forward the essence of TCM culture. At the same time, CBL teaching is adopted to promote the integrated and people-oriented teaching concept of TCM, with medical students as the main body and teachers as the supporting role. The training with this model can effectively improve the clinical skills and development potential of TCM students.
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Objective:To investigate the application effect of a sequential clinical skill curriculum system in standardized residency training.Methods:A total of 300 residents who participated in the residency training of a clinical medical school from 2020 to 2022 were selected as the research subjects, among whom 46 residents in the experimental group had received the clinical skill training course of the clinical medical school in the undergraduate stage, and 254 in the control group had not received such training in the undergraduate stage. The teaching effect of the two groups was observed from the first year to the third year after they entered the residency training base and were trained together based on the curriculum system. SPSS 24.0 statistical software was used for data analysis, and the main statistical methods included descriptive analysis, the Kolmogorov-Smirnov test, the Mann-Whitney U test, and the chi-square test. Results:Before the residents entered the residency base, class 2020 [60.0(52.0,60.0) vs. 51.0(48.0,53.0)], class 2021 [54.0(52.0,56.0) vs. 51.0(48.0,53.0)] and class 2022 [53.0(51.0,55.0) vs. 50.0(47.0,51.0)] The difference between the entry base grades of the residents in the experimental group compared to the control group was statistically significant ( P<0.05). After 36 months of residency training, the difference between the residents in the trial group and the control group in the 2020 class was not statistically significant when it came to the passing rate of the final exam ( χ2=1.20, P=0.273). At the end of 12 months of residency training, there was a statistically significant difference ( P<0.05) between the scores of residents in the experimental group compared with the control group in the theoretical examination [124.0 (123.8,125.0) vs. 115.0 (101.0,125.0)] and medical history taking [92.0 (91.0,95.0) vs. 85.1 (79.3,94.5)]. The differences were not statistically significant ( P>0.05) at the end of 6, 18, and 24 months of residency training. At the end of 6 months [93.0(90.0,97.0) vs. 89.0(86.3,95.0)], 12 months [94.0(92.0,95.0) vs. 89.0(87.0,92.0)] and 18 months [90.0(86.5,93.5) vs. 81.0(69.0,91.0)] of residency training, residents in the experimental group Physical examination scores were statistically significant compared to the control group ( P<0.05). At the end of 24 months of residency training, there was no statistically significant difference ( P>0.05) between the physical examination scores of residents in the experimental group compared with the control group in the classes of 2020 [92.0(87.5,95.3) vs. 85.0(79.0,92.0)] and 2021 [94.0(87.0,96.0) vs. 90.0(84.0,95.0)]. Conclusions:The clinical skill curriculum system can help to improve the comprehensive clinical ability of residents, and the teaching contents and methods of physical examination should be further optimized, with a focus on the training of doctor-patient communication skills and humanistic literacy among residents in the future.
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Objective:To explore the value of subspecialty group collaboration combined with disease checklist-driven learning in overcoming the impact of the specialized disease treatment mode in subspecialty establishment on the cultivation of professional postgraduate students.Methods:In the teaching of general surgery and gastroenterology, sixty professional postgraduate students of grade 2019 were randomly divided into control group and experimental group, with 30 students in each group. The control group received traditional teaching, while the experimental group received the teaching mode of subspecialty group collaboration combined with disease checklist-driven learning. The teaching effectiveness and the degree of satisfaction with teaching were compared between the two groups. The data were analyzed using the t test and the chi-squared test using SPSS 20.0. Results:In actual teaching, compared with the control group, the experimental group showed significantly higher scores of theoretical assessment (71.51±11.32 vs. 87.23±10.51, P<0.05) and case analysis (73.61±6.82 vs. 92.37±6.87, P<0.05). The rates of satisfaction with theoretical knowledge learning, application of clinical thinking ability for diseases, teaching organization forms, and teaching effectiveness were 90.00%(27/30), 86.67%(26/30), 96.67%(29/30), and 93.33%(28/30) in the experimental group, respectively, which were significantly higher than those of the control group [40.00%(12/30), 23.33%(7/30), 40.00%(12/30), and 46.67%(14/30), respectively; all P<0.05]. Conclusions:The subspecialty group collaboration combined with disease checklist-driven learning mode can overcome the problems of "narrow disease spectrum and narrow knowledge scope" in specialized postgraduate education, and guide students to break the teaching barriers generated by subspecialty construction to create a new form of comprehensive and multi-disease learning, with good prospects for promotion and application.
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@#Although evidence-based teaching has been adopted in various learning disciplines, its adoption in medical education remains challenging. To graduate a full-fledged well-rounded physician equipped to face the real-world challenges of diagnosis and treating diseases is the ultimate goal of every medical institution. Medical students’ clinical competence is anchored on the approach of facilitators’ acquired teaching expertise and how they apply learned techniques to connect basic knowledge to clinical skill enhancement. Are these approaches within the realm of evidence-based teaching? The subsequent discussion will elaborate on proven effective strategies [Problem-Based Learning (PBL), Outcome-Based Education (OBE)] and how a strategic teaching and learning tool [Target-Oriented Clinical Skill Enhancement (TOCSE)] has proven to address the issue.
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Education, MedicalABSTRACT
Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.
Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students' difficulty in developing clinical reasoning.
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ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.