Nechinyakare, vadzidzisi vakadzidzisa kuongorora kwemuviri (PE) kune vatsva vekurapa (vanodzidzira), kunyangwe zvipingamupinyi nekutora uye mutengo, pamwe nematambudziko ane akajairwa matekiniki.
Isu tinokurudzira modhi inoshandisa zvikwata zvakamisikidzwa zvevarairidzi vevarwere (SPIs) uye vegore rechina vadzidzi vezvokurapa (MS4s) kudzidzisa makirasi edzidzo yemuviri kuvadzidzi vekare, vachitora mukana wakazara wekubatana uye nekubatsira-vezera kudzidza.
Ongororo yepre-sevhisi, MS4 uye vadzidzi veSPI vakaratidza maonero akanaka echirongwa ichi, nevadzidzi veMS4 vachishuma kuvandudzwa kwakakura mukuzivikanwa kwavo kwehunyanzvi sevadzidzisi.Pre-practice vadzidzi 'kuita pachirimo kiriniki unyanzvi bvunzo akanga akaenzana kana nani pane pre-program vezera' kuita kwavo.
Chikwata cheSPI-MS4 chinogona kunyatso kudzidzisa vadzidzi vekutanga makanika uye kiriniki hwaro hwekuongororwa kwemuviri.
Vadzidzi vatsva vezvokurapa (pre-medical vadzidzi) vanodzidza bvunzo yekutanga yemuviri (PE) pakutanga kwechikoro chekurapa.Ita makirasi ezvidzidzo zvemuviri zvevadzidzi vechikoro chekugadzirira.Pachivanhu, kushandiswa kwevadzidzisi kunewo zvakaipira, zvinoti: 1) zvinodhura;3) vanonetsa kuunganidza;4) ivo vakaoma kuenzanisa;5) nuances inogona kubuda;akapotsa uye ari pachena zvikanganiso [1, 2] 6) Angave asina ruzivo nezvehumbowo-hwaro nzira dzekudzidzisa [3] 7) Anogona kunzwa kuti dzidzo yemuviri kugona kudzidzisa hakuna kukwana [4];
Kubudirira maitiro ekudzidzira maitiro akagadzirwa achishandisa varwere chaivo [5], vadzidzi vepamusoro vezvokurapa kana vagari [6, 7], uye vanhu vakarara [8] sevadzidzisi.Zvakakosha kuziva kuti yose iyi mienzaniso yakafanana kuti kushanda kwevadzidzi muzvidzidzo zvekudzidzira muviri hakudziki nekuda kwekusabatanidzwa kwevadzidzisi [5, 7].Nekudaro, vadzidzisi vakarara havana ruzivo mune zvekiriniki mamiriro [9], izvo zvakakosha kuti vadzidzi vakwanise kushandisa data yemitambo kuyedza kuongororwa kwekufungidzira.Kugadzirisa kudiwa kwekumisikidzwa uye mamiriro ekiriniki mukudzidzisa kwepanyama kudzidzisa, boka revadzidzisi rakawedzera hypothesis-inotungamirwa diagnostic maitiro kune yavo yekudzidzisa [10].PaGeorge Washington University (GWU) Chikoro cheMishonga, tiri kugadzirisa chinodikanwa ichi kuburikidza nemuenzaniso wezvikwata zvakamira zvevadzidzisi vevarwere (SPIs) uye vadzidzi vepamusoro vezvokurapa (MS4s).(Mufananidzo 1) SPI inobatanidzwa neMS4 kudzidzisa PE kune vanodzidzira.SPI inopa hunyanzvi mumakanika eMS4 bvunzo mune yekiriniki mamiriro.Uyu modhi unoshandisa kudzidza pamwe chete, chinova chishandiso chine simba chekudzidza [11].Nekuti SP inoshandiswa munenge muzvikoro zvese zvekurapa zveUS uye zvikoro zvakawanda zvepasi rose [12, 13], uye zvikoro zvakawanda zvekurapa zvine zvirongwa zvevadzidzi-faculty, modhi iyi ine mukana wekushandisa kwakakura.Chinangwa chechinyorwa ichi ndechekutsanangura iyi yakasarudzika SPI-MS4 timu yemitambo yekudzidzira modhi (Mufananidzo 1).
Tsanangudzo pfupi yeMS4-SPI yekudyidzana modhi yekudzidza.MS4: Gore Rechina Mudzidzi Wezvokurapa Mudzidzi SPI: Murayiridzi Wemurwere Akagadziriswa;
Kuongororwa kwemuviri kunodiwa (PDX) kuGWU chimwe chikamu chepre-clerkship clinical skills course in medicine.Zvimwe zvikamu: 1) Kubatanidzwa kwekliniki (mapoka eboka anobva paPBL nheyo);2) Hurukuro;3) Formative maekisesaizi OSCE;4) Kudzidziswa kwekliniki (kushandiswa kwehutano hwehutano nekuita vanachiremba);5) Kudzidzisa kwekusimudzira kwehunyanzvi;PDX inoshanda mumapoka evadzidzi 4-5 vanoshanda pachikwata chimwe chete cheSPI-MS4, vachisangana katanhatu pagore kwemaawa matatu mumwe nemumwe.Saizi yekirasi ingangoita vadzidzi zana nemakumi masere, uye gore rega rega pakati pemakumi matanhatu ne90 MS4 vadzidzi vanosarudzwa sevadzidzisi vePDX makosi.
MS4s inogashira kudzidziswa kwevadzidzisi kuburikidza neTALKS (Ruzivo rweKudzidzisa uye Unyanzvi) yedu yepamusoro yevarairidzi, iyo inosanganisira misangano yemisimboti yekudzidza kwevanhu vakuru, hunyanzvi hwekudzidzisa, uye kupa mhinduro [14].MaSPI anoita chirongwa chakasimba chekudzidzisa kwenguva refu chakagadzirwa neCLASS Simulation Center Assistant Director (JO).Zvidzidzo zveSP zvakarongwa zvakatenderedza nhungamiro dzakagadzirwa nevadzidzisi dzinosanganisira misimboti yekudzidza kwevanhu vakuru, mataira ekudzidza, uye hutungamiriri hweboka nekurudziro.Kunyanya, kudzidziswa kweSPI uye kumira kunoitika muzvikamu zvakati wandei, kutanga muzhizha uye kuenderera mukati megore rechikoro.Zvidzidzo zvinosanganisira kudzidzisa, kutaurirana uye kuita makirasi;kuti chidzidzo chacho chinopindirana sei mune imwe kosi yose;nzira yekupa mhinduro;maitiro ekuita maekisesaizi emuviri uye kuvadzidzisa kuvadzidzi.Kuti uongorore kugona kwechirongwa, maSPI anofanirwa kupasa bvunzo yekuisa inotungamirwa nenhengo yeSP faculty.
MS4 neSPI zvakatorawo chikamu mumusangano wechikwata chemaawa maviri pamwe chete kutsanangura mabasa avo ekuwedzera mukuronga nekushandisa kosi uye kuongorora vadzidzi vari kupinda mukudzidziswa kwepamberi.Chimiro chekutanga chemusangano chaive chimiro cheGRPI (zvinangwa, mabasa, maitiro uye hukama hwevanhu) uye dzidziso yeMezirow yeshanduko yekudzidza (maitiro, nzvimbo uye zvirimo) yekudzidzisa pfungwa dzekudzidza dzakasiyana-siyana (dzakawedzerwa) [15, 16].Kushanda pamwe chete sevadzidzisi pamwe chete kunopindirana nemagariro uye ruzivo rwekudzidza dzidziso: kudzidza kunogadzirwa mukutsinhana kwevanhu pakati penhengo dzechikwata [17].
Iyo PDX kosi yakarongedzerwa yakatenderedza Core uye Clusters (C + C) modhi [18] yekudzidzisa PE mumamiriro ekufunga kwekiriniki pamusoro pemwedzi gumi nemisere, ine kirasi yega yega curriculum yakanangana neyakajairwa murwere mharidzo.Vadzidzi vanozotanga kudzidza chikamu chekutanga cheC + C, bvunzo ye40-mubvunzo mota inovhara maorgan system makuru.Bvunzo yehwaro bvunzo yakapfava uye inoshanda yemuviri isinganyanyi kubhadharisa mutero pane yechinyakare bvunzo.Mabvunzo eCore akanakira kugadzirira vadzidzi ruzivo rwekutanga kukiriniki uye inogamuchirwa nezvikoro zvakawanda.Vadzidzi vanobva vaenda kuchikamu chechipiri cheC+C, Diagnostic Cluster, rinova boka reH&Ps rinofambiswa nekufungidzira rakarongwa zvakatenderedza zvakajairwa zviratidziro zvekiriniki zvakagadzirirwa kuvandudza hunyanzvi hwekufunga kwekiriniki.Kurwadziwa kwechifuva muenzaniso wekuratidzwa kwekliniki yakadaro (Table 1).Masumbu anobvisa zviitwa zvepakati kubva pakuongorora kwekutanga (semuenzaniso, chiyero chemoyo auscultation) uye kuwedzera zvimwe, zviitiko zvehunyanzvi zvinobatsira kusiyanisa kugona kwekuongorora (semuenzaniso, kuterera mamwe manzwi emwoyo munzvimbo yelateral decubitus).C+C inodzidziswa kwenhambo yemwedzi gumi nemisere uye kosi yefundo inoenderera mberi, vadzidzi vachitanga kudzidziswa mubvunzo dzinosvika makumi mana dzepakati pemotokari uyezve, kana vagadzirira, vachifamba mumapoka, mumwe nemumwe achiratidza mashandiro ekiriniki anomiririra organ system module.mudzidzi anoona (semuenzaniso, kurwadziwa kwechipfuva uye kupfupika kwekufema panguva yekudzivirira kwemoyo) (Table 2).
Mukugadzirira kosi yePDX, vadzidzi vepre-doctoral vanodzidza maitiro akakodzera ekuongorora (Mufananidzo 2) uye kudzidziswa kwemuviri mugwaro rePDX, bhuku rekuongorora muviri, uye mavhidhiyo anotsanangura.Iyo yakazara nguva inodiwa kuti vadzidzi vagadzirire kosi ingangoita 60-90 maminetsi.Inosanganisira kuverenga iyo Cluster Packet (12 mapeji), kuverenga Bates chitsauko (~20 mapeji), uye kuona vhidhiyo (2-6 maminitsi) [19].Chikwata cheMS4-SPI chinoitisa misangano nenzira inowirirana chichishandisa manyorerwo akataurwa mubhuku rekushandisa (Table 1).Vanotanga kutora bvunzo yemuromo (kazhinji mibvunzo 5-7) pamusoro peruzivo rwepamberi (semuenzaniso, chii chinonzi physiology uye kukosha kweS3? Chii chinoongororwa chinotsigira kuvapo kwayo kune varwere vane kufema kwenguva pfupi?).Vanobva vaongorora mapuroteni ekuongorora uye kubvisa kusahadzika kwevadzidzi vanopinda pre-graduate kudzidziswa.Zvasara zvekosi zviitwa zvekupedzisira.Kutanga, vadzidzi vanogadzirira kudzidzira kurovedza muviri pane mumwe nemumwe uye paSPI uye kupa mhinduro kuchikwata.Pakupedzisira, SPI yakavapa chidzidzo che "Small Formative OSCE."Vadzidzi vakashanda vaviri vaviri kuti vaverenge nyaya uye kuita fungidziro pamusoro pezviitwa zverusarura zvakaitwa paSPI.Zvadaro, zvichibva pamhedzisiro yefizikisi simulation, vadzidzi vasati vapedza kudzidza vanoisa mberi fungidziro uye vanopa zano rinonyanya kufungidzira.Mushure mekosi, timu yeSPI-MS4 yakaongorora mudzidzi wega wega ndokuzozviongorora uye yakaratidza nzvimbo dzekuvandudza pakudzidziswa kunotevera (Table 1).Mhinduro ndicho chinhu chakakosha chekosi.SPI neMS4 inopa pa-the-fly formative mhinduro panguva yega yega: 1) apo vadzidzi vanoita maekisesaizi kune mumwe nemumwe uye paSPI 2) panguva yeMini-OSCE, SPI inotarisa kumakanika uye MS4 inotarisa pakufunga kwekiriniki;SPI neMS4 inopawo zviri pamutemo zvakanyorwa muchidimbu mhinduro pakupera kwemesita yega yega.Iyi mhinduro yepamutemo inopinzwa mu online medical education management system rubric pakupera kwemesita yega yega uye inokanganisa giredhi rekupedzisira.
Vadzidzi vari kugadzirira internship vakagovana pfungwa dzavo pane zvakaitika muongororo yakaitwa neGeorge Washington University Dhipatimendi reAssessment uye Dzidzo Tsvagiridzo.Makumi makumi mapfumbamwe nemanomwe muzana evadzidzi vepasi pedhigirii vakabvuma zvakasimba kana kubvuma kuti kosi yekuongorora yemuviri yaive yakakosha uye yaisanganisira zvinotsanangura:
“Ndinodavira kuti makosi okuongorora muviri ndiwo dzidzo yokurapa yakanakisisa;semuenzaniso, paunodzidzisa kubva pakuona kwemudzidzi wegore rechina uye murwere, zvishandiso zvine chekuita uye zvinosimbiswa nezviri kuitwa mukirasi.
"SPI inopa mazano akanaka kwazvo pamusoro penzira dzinoshanda dzekuita maitiro uye inopa zano rakanakisa pane nuances inogona kukonzera kusagadzikana kuvarwere."
“SPI neMS4 zvinoshanda pamwe chete zvakanaka uye zvinopa maonero matsva pakudzidzisa akakosha zvakanyanya.MS4 inopa nzwisiso muzvinangwa zvekudzidzisa mukuita kwekiriniki.
“Ndinoda kuti tisangane kakawanda.Ichi ndicho chikamu chandinofarira chekosi yekurapa uye ndinonzwa sekunge inopera nekukurumidza. "
Pakati pevakapindura, 100% yeSPI (N = 16 [100%]) uye MS4 (N = 44 [77%]) vakati ruzivo rwavo semudzidzisi wePDX rwakanga rwakanaka;91% uye 93%, maererano, yeSPIs uye MS4s vakati vane ruzivo semudzidzisi wePDX;ruzivo rwakanaka rwekushanda pamwe chete.
Ongororo yedu yehunhu yemaonero eMS4's ezvavaikoshesa muzviitiko zvavo sevadzidzisi zvakaguma nemadingindira anotevera: 1) Kushandisa dzidziso yekudzidza kwevanhu vakuru: kukurudzira vadzidzi nekugadzira nzvimbo yekudzidza yakachengeteka.2) Kugadzirira kudzidzisa: kuronga chirongwa chekiriniki chakakodzera, kutarisira mibvunzo yevadzidzi, nekubatana kutsvaga mhinduro;3) Modelling professionalism;4) Kupfuura zvinotarisirwa: kukurumidza kusvika uye kusiya nguva;5) Mhinduro: tungamira panguva yakakodzera, ine chinangwa, inosimbisa uye inovaka mhinduro;Ipa vanodzidzira mazano pamusoro pemaitiro ekudzidza, nzira yakanakisisa yekupedza zvidzidzo zvekuongorora muviri, uye mazano emabasa.
Vadzidzi veNheyo vanotora chikamu mune matatu-chikamu chekupedzisira OSCE bvunzo pakupera kwechirimo semester.Kuti tiongorore kushanda kwechirongwa chedu, takaenzanisa mashandiro evadzidzi vanodzidzira basa muchikamu chefizikisi cheOSCE chirongwa ichi chisati chatanga uye mushure mekutanga muna 2010. Gore ra2010 risati rasvika, vadzidzisi vechiremba veMS4 vakadzidzisa PDX kuvadzidzi vasati vapedza kudzidza.Kunze kwegore reshanduko ra2010, takaenzanisa zviratidzo zveOSCE zvedzidzo yemuviri muna 2007–2009 nezviratidzo zve2011–2014.Huwandu hwevadzidzi vari kutora chikamu muOSCE hwakabva pa170 kusvika ku185 pagore: vadzidzi mazana mashanu nemakumi matatu nevaviri vari muboka rekutanga-kupindira uye vadzidzi mazana manomwe nenomwe muboka repashure-kupindira.
Zvibodzwa zveOSCE kubva 2007-2009 uye 2011-2014 bvunzo dzechirimo zvinopfupikiswa, zvichiyerwa nesaizi yegore remuenzaniso.Shandisa 2 samples kuenzanisa iyo yakawedzera GPA yegore rega rega renguva yapfuura necumulative GPA yenguva inotevera uchishandisa t-bvunzo.GW IRB yakaregerera chidzidzo ichi uye yakawana mvumo yemudzidzi yekusaziva zita ravo rekushandisa pakudzidza.
Izvo zvinoreva chikamu chekuongorora chemuviri chikamu chakawedzera zvakanyanya kubva ku83.4 (SD = 7.3, n = 532) pamberi pechirongwa kusvika ku89.9 (SD = 8.6, n = 714) mushure mechirongwa (kureva shanduko = 6, 5; 95% CI: 5.6 kusvika 7.4; p<0.0001) (Tafura 3).Nekudaro, sezvo shanduko kubva pakudzidzisa kuenda kuvashandi vasiri vadzidzisi ichienderana neshanduko mukharikhulamu, misiyano yezvikoro zveOSCE haigone kutsanangurwa zvakajeka nehunyanzvi.
Iyo SPI-MS4 timu yekudzidzisa modhi inzira itsva yekudzidzisa ruzivo rwekutanga rwedzidzo yemuviri kuvadzidzi vekurapa kuti vagadzirire kuratidzwa kwekiriniki yekutanga.Izvi zvinopa imwe nzira inoshanda nekunzvenga zvipingaidzo zvine chekuita nekutora chikamu kwevadzidzisi.Inopawo kukosha kwakawedzerwa kuchikwata chekudzidzisa uye vadzidzi vavo vasati vadzidzira: vese vanobatsirwa nekudzidza pamwechete.Mabhenefiti anosanganisira kufumura vadzidzi vasati vadzidzira kune akasiyana maonero uye mienzaniso yekubatana [23].Mamwe maonero anowanikwa mukudzidza kwakabatana anoumba nharaunda yekuvaka [10] umo vadzidzi ava vanowana ruzivo kubva kune mbiri zvinyorwa: 1) kinesthetic - kuvaka chaiyo yekurovedza muviri maitiro, 2) kugadzira - kuvaka kuongorora kufunga.MS4s zvakare inobatsirwa nekudzidza kwakabatana, kuvagadzirira kune ramangwana rekuita basa rekuita nevanodyidzana vehutano.
Muenzaniso wedu unosanganisirawo zvakanakira kudzidza nevezera [24].Pre-practice vadzidzi vanobatsirwa kubva mukurongeka kwekuziva, nzvimbo yekudzidza yakachengeteka, MS4 kushamwaridzana uye muenzaniso wekuita, uye "kudzidza kaviri" -kubva pakudzidza kwavo kwekutanga uye kwevamwe;Vanoratidzawo budiriro yavo yehunyanzvi nekudzidzisa vechidiki vezera ravo uye kushandisa mikana inotungamirwa nevadzidzisi kukudziridza nekuvandudza hunyanzvi hwavo hwekudzidzisa nebvunzo.Mukuwedzera, ruzivo rwavo rwokudzidzisa runovagadzirira kuva vadzidzisi vanobudirira kupfurikidza nokuvarovedza kushandisa mitoo yokudzidzisa yakavakirwa paufakazi.
Zvidzidzo zvakadzidzwa panguva yekushandiswa kwemuenzaniso uyu.Chekutanga, zvakakosha kuziva kuomarara kwehukama hwepakati peMS4 neSPI, sezvo mamwe madhidhi achishaya kunzwisisa kwakajeka kwepamusoro pekushanda pamwe chete.Mabasa akajeka, mabhuku ezvinyorwa uye misangano yemapoka zvinogadzirisa nyaya idzi.Chechipiri, kudzidziswa kwakadzama kunofanirwa kupihwa kukwenenzvera mabasa echikwata.Nepo ese ese maviri evarairidzi achifanira kudzidziswa kudzidzisa, SPI inodawo kudzidziswa maitiro ekuita hunyanzvi hwebvunzo hwatove neMS4.Chechitatu, kuronga zvine hungwaru kunodiwa kuitisa chirongwa chakabatikana cheMS4 uye kuona kuti timu yese iripo pachikamu chega chega chekuongorora muviri.Chechina, zvirongwa zvitsva zvinotarisirwa kutarisana nekupikisa kubva kuvadzidzisi nehutungamiri, nenharo dzakasimba mukufarira mari-inoshanda;
Mukupfupisa, iyo SPI-MS4 yemuviri diagnostic yekudzidzisa modhi inomiririra yakasarudzika uye inoshanda curricular innovation kuburikidza iyo vadzidzi vekurapa vanogona kubudirira kudzidza hunyanzvi hwemuviri kubva kune vakanyatsodzidziswa vasina chiremba.Sezvo zvingangoita zvikoro zvese zvekurapa muUnited States uye zvikoro zvakawanda zvekurapa zvekunze zvinoshandisa SP, uye zvikoro zvakawanda zvekurapa zvine zvirongwa zvevadzidzi, modhi iyi ine mukana wekushandisa kwakafara.
Dataset yeongororo iyi inowanikwa kubva kuna Dr. Benjamin Blatt, MD, Mutungamiriri weGWU Study Center.Yese data yedu inounzwa muchidzidzo.
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Nguva yekutumira: May-11-2024