Ngokwesiko, ootitshala baye bafundisa uviwo lomzimba (PE) kubantu abatsha bezonyango (abaqeqeshwayo), nangona imingeni yokuqashwa kunye neendleko, kunye nemingeni ngeendlela ezisemgangathweni.
Sicebisa imodeli esebenzisa amaqela asemgangathweni abafundisi bezigulane (SPIs) kunye nabafundi bezonyango bonyaka wesine (MS4s) ukufundisa iiklasi zemfundo yezomzimba kubafundi bezonyango, besebenzisa ithuba elipheleleyo lokufunda ngokubambisana kunye nokuncedisa oontanga.
Uphononongo lwaphambi kokungenela inkonzo, abafundi be-MS4 kunye nabafundi be-SPI lubonakalise iimbono ezikhuthazayo ngeprogram, abafundi be-MS4 banike ingxelo yophuculo olubonakalayo kubuchwephesha babo njengabahlohli.Indlela abafundi abaqhuba ngayo kwiimviwo zezakhono zeklinikhi zasentlakohlaza yayilingana okanye ingcono kunentsebenzo yoontanga babo bangaphambi kweprogram.
Iqela le-SPI-MS4 linokufundisa ngempumelelo abafundi abasaqalayo ubuxhakaxhaka kunye nesiseko seklinikhi sovavanyo lomzimba lwabasaqalayo.
Abafundi abatsha bezonyango (abafundi bezonyango) bafunda uviwo olusisiseko lomzimba (PE) ekuqaleni kwesikolo sezonyango.Ukuqhuba iiklasi zemfundo yezomzimba kubafundi besikolo sokulungiselela.Ngokwemveli, ukusetyenziswa kootitshala nako kuneengxaki ezizezi: 1) bayabiza;3) kunzima ukugaya;4) kunzima ukulinganisa;5) ama-nuances angavela;iimpazamo eziphosiweyo nezicacileyo [1, 2] 6) Usenokungazazi iindlela zokufundisa ezisekelwe kubungqina [3] 7) Basenokuvakalelwa kukuba izakhono zokufundisa ngemfundo yomzimba azanelanga [4];
Imifuziselo yoqeqesho oluyimpumelelo yoqeqesho iphuhliswe kusetyenziswa izigulana zokwenyani [5], abafundi bezonyango abaphezulu okanye abahlali [6, 7], kunye nabantu abaleleyo [8] njengabahlohli.Kubalulekile ukuqaphela ukuba yonke le mifuziselo iyafana ukuba ukusebenza kwabafundi kwizifundo zemfundo yomzimba akunciphi ngenxa yokungabandakanyi inxaxheba kootitshala [5, 7].Nangona kunjalo, abafundisi-ntsapho abanamava kwimeko yeklinikhi [9], ebaluleke kakhulu kubafundi ukuba bakwazi ukusebenzisa idatha yezemidlalo ukuvavanya iingcamango zokuxilonga.Ukujongana nemfuno yokubekwa emgangathweni kunye nomxholo weklinikhi ekufundiseni ngokomzimba, iqela lootitshala longeze i-hypothesis-driven drives diagnostic exercises ekufundiseni kwabo [10].KwiYunivesithi yaseGeorge Washington (GWU) School of Medicine, sijongene nale mfuno ngokusebenzisa imodeli yamaqela asemgangathweni abafundisi bezigulane (SPIs) kunye nabafundi bezonyango eziphezulu (MS4s).(Umfanekiso 1) I-SPI idityaniswe ne-MS4 ukufundisa i-PE kubaqeqeshwa.I-SPI ibonelela ngobuchule kumatshini woviwo lwe-MS4 kwimeko yeklinikhi.Lo mzekelo usebenzisa ukufunda ngentsebenziswano, esisixhobo sokufunda esinamandla [11].Ngenxa yokuba i-SP isetyenziswa phantse kuzo zonke izikolo zonyango zase-US nakwizikolo ezininzi zamazwe ngamazwe [12, 13], kunye nezikolo ezininzi zonyango zineenkqubo zefakhalthi yabafundi, le modeli inamandla okusetyenziswa ngokubanzi.Injongo yale nqaku kukuchaza le modeli yoqeqesho yeqela le-SPI-MS4 ekhethekileyo (Umfanekiso 1).
Inkcazo emfutshane yemodeli yokufunda yentsebenziswano ye-MS4-SPI.I-MS4: Unyaka weSine woMfundi wezoNyango we-SPI: uMyaleli weSigulana oMiselweyo;
Uxilongo olufunekayo lokuxilongwa komzimba (PDX) kwi-GWU lelinye icandelo lekhosi yezakhono zeklinikhi zaphambi kokuba ngumabhalana kwezamayeza.Amanye amacandelo: 1) Ukuhlanganiswa kweklinikhi (iiseshoni zeqela ezisekelwe kumgaqo we-PBL);2) Udliwano-ndlebe;3) Ukuzivocavoca okwenziwayo OSCE;4) Uqeqesho lweklinikhi (ukusetyenziswa kwezakhono zonyango ngokwenza oogqirha);5) Ukuqeqesha kuphuhliso lobungcali;I-PDX isebenza ngamaqela abaqeqeshi be-4-5 abasebenza kwiqela elifanayo le-SPI-MS4, badibana namaxesha ama-6 ngonyaka kwiiyure ze-3 nganye.Ubungakanani beklasi bumalunga ne-180 labafundi, kwaye nyaka ngamnye phakathi kwama-60 nama-90 abafundi beMS4 bakhethwa njengootitshala kwiikhosi zePDX.
I-MS4s ifumana uqeqesho lootitshala ngokusebenzisa i-TALKS (uLwazi lokuFundisa neZakhono) yethu yonyulo oluphezulu lootitshala, olubandakanya iindibano zocweyo ngemigaqo yokufunda yabantu abadala, izakhono zokufundisa, kunye nokunika ingxelo [14].I-SPIs ingena kwinkqubo yoqeqesho olubanzi lwelongitudinal ephuhliswe nguMlawuli onguNcedisayo weZiko lokulinganisa le-CLASS (JO).Iikhosi ze-SP zicwangciswe ngokwezikhokelo eziphuhliswe ngutitshala ezibandakanya imigaqo yokufunda yabantu abadala, iindlela zokufunda, nobunkokeli beqela kunye nenkuthazo.Ngokukodwa, uqeqesho lweSPI kunye nokubekwa emgangathweni kwenzeka kwizigaba ezininzi, ukuqala ehlotyeni nokuqhubeka unyaka wonke wesikolo.Izifundo ziquka indlela yokufundisa, ukunxibelelana nokuqhuba iiklasi;indlela esingena ngayo isifundo kwisifundo eso;indlela yokubonelela ngengxelo;indlela yokwenza imithambo yomzimba kwaye ubafundise abafundi.Ukuvavanya ukufaneleka kweprogram, ii-SPIs kufuneka ziphumelele uvavanyo lokubeka indawo olulawulwa lilungu le-SP faculty.
I-MS4 kunye ne-SPI nazo zithathe inxaxheba kucweyo lweeyure ezimbini zeqela kunye ukuchaza indima encedisanayo ekucwangciseni nasekuphumezeni ikharityhulam nokuvavanya abafundi abangena kuqeqesho lwaphambi kokungena enkonzweni.Ulwakhiwo olusisiseko lweworkshop yayiyimodeli ye-GRPI (iinjongo, iindima, iinkqubo kunye neemeko zokusebenzisana kwabantu) kunye nethiyori ye-Mezirow yenguqu yokufunda (inkqubo, indawo kunye nomxholo) yokufundisa iikhonsepthi zokufunda ezibandakanya izifundo (zongezelelweyo) [15, 16].Ukusebenza kunye njengabafundisi-ntsapho kuhambelana neengcamango zokufunda zentlalo kunye namava: ukufunda kudalwe kutshintshiselwano lwentlalo phakathi kwamalungu eqela [17].
Ikharityhulam ye-PDX yakhiwe malunga nemodeli ye-Core kunye ne-C+C [18] yokufundisa i-PE kwimeko yeklinikhi yokuqiqa kwisithuba seenyanga ezili-18, kunye nekharityhulam yeklasta nganye igxininise kwiinkcazo eziqhelekileyo zesigulana.Abafundi baya kuqala ukufunda icandelo lokuqala C+C, a 40-umbuzo motor uviwo egubungela iinkqubo amalungu ezinkulu.Uviwo lokwandlalela luvavanyo lomzimba olulula nolusebenzayo olungarhafisi kakhulu ngokwengqondo kunoviwo lwesintu jikelele.Iimviwo ezingundoqo zilungele ukulungiselela abafundi amava ekliniki kwaye zamkelwa zizikolo ezininzi.Abafundi ke badlulela kwicandelo lesibini le-C+C, iCluster yoDiagnostic, eliqela le-H&Ps eliqhutywa yi-hypothesis eliququzelelwe malunga neenkcazo-ntetho eziqhelekileyo zeklinikhi ezenzelwe ukuphuhlisa izakhono zokuqiqa zonyango.Intlungu yesifuba ngumzekelo wokubonakaliswa kweklinikhi enjalo (Itheyibhile 1).Amaqela akhupha imisebenzi engundoqo kuviwo oluphambili (umzekelo, i-basic auscultation ye-cardiac) kwaye yongeza imisebenzi eyongezelelweyo, ekhethekileyo enceda ukwahlula amandla okuxilonga (umzekelo, ukuphulaphula izandi zentliziyo eyongezelelweyo kwi-lateral decubitus position).I-C+C ifundiswa kwisithuba seenyanga ezili-18 kwaye ikharityhulamu iyaqhubeka, nabafundi baqale baqeqeshwe malunga neemviwo ezingundoqo zemoto ezimalunga nama-40 kwaye emva koko, xa sele belungile, bahambe babe ngamaqela, ngalinye libonisa ukusebenza kwekliniki emele imodyuli yesistim yamalungu.amava omfundi (umzekelo, iintlungu zesifuba kunye nokuphefumla kancinci ngexesha lokuvaleka kwentliziyo) (Itheyibhile 2).
Ukulungiselela ikhosi yePDX, abafundi be-pre-doctoral bafunda iiprothokholi ezifanelekileyo zokuxilonga (Umfanekiso 2) kunye noqeqesho lomzimba kwi-PDX manual, incwadi yokuxilonga ngokomzimba, kunye neevidiyo ezicacileyo.Ixesha lilonke elifunekayo ukuze abafundi balungiselele ikhosi malunga nemizuzu engama-60-90.Iquka ukufunda i-Cluster Packet (amaphepha e-12), ukufunda isahluko seBates (~ 20 amaphepha), kunye nokubukela ividiyo (imizuzu eyi-2-6) [19].Iqela le-MS4-SPI liqhuba iintlanganiso ngendlela engaguqukiyo lisebenzisa ifomathi echazwe kwincwadana yemigaqo (iThebhile 1).Baqala bathathe uvavanyo lomlomo (ngokuqhelekileyo imibuzo emi-5-7) kulwazi lwangaphambili (umzekelo, yintoni i-physiology kunye nokubaluleka kwe-S3? Yintoni ukuxilongwa exhasa ubukho bayo kwizigulane ezinokuphefumula okufutshane?).Emva koko baye baphonononge iiprothokholi zokuxilonga kwaye basuse amathandabuzo kubafundi abangena kuqeqesho lwangaphambi kwesidanga.Intsalela yekhosi yimisebenzi yokugqibela.Okokuqala, abafundi balungiselela ukuziqhelanisa nemithambo yomzimba omnye komnye nakwiSPI kwaye banike ingxelo kwiqela.Ekugqibeleni, i-SPI yabanika isifundo se-"Small Formative OSCE."Abafundi basebenze ngababini ukuze bafunde ibali kwaye benze intelekelelo malunga nemisebenzi yocalucalulo eyenziwa kwiSPI.Ke, ngokusekwe kwiziphumo zefiziksi yokulinganisa, abafundi abangekathweswa isidanga babeka phambili ii-hypotheses kwaye bacebise olona xilongo lunokwenzeka.Emva kwekhosi, iqela le-SPI-MS4 livavanye umfundi ngamnye emva koko lazihlola laza lachonga iinkalo zokuphucula uqeqesho olulandelayo (iThebhile 1).Ingxelo yinto ephambili yekhosi.I-SPI kunye ne-MS4 zibonelela ngengxelo ye-formative on-the-fly ngexesha leseshoni nganye: 1) njengoko abafundi benza umsebenzi omnye komnye kunye ne-SPI 2) ngexesha le-Mini-OSCE, i-SPI igxile kumatshini kwaye i-MS4 igxile kwingqiqo yeklinikhi;I-SPI ne-MS4 zikwabonelela ngengxelo eshwankathelweyo ebhaliweyo esesikweni ekupheleni kwesiqingatha sonyaka.Le ngxelo isemthethweni ifakwe kwirubrikhi yenkqubo yolawulo lwemfundo yezonyango kwi-intanethi ekupheleni kwesemester nganye kwaye ichaphazela ibakala lokugqibela.
Abafundi abalungiselela i-internship babelane ngeengcinga zabo kumava kuphando olwenziwe liSebe leYunivesithi yaseGeorge Washington yoVavanyo kunye noPhando lweMfundo.Amashumi alithoba anesixhenxe ekhulwini abafundi abangekabinazidanga bavuma ngamandla okanye bavuma ukuba ikhosi yokuxilonga ngokwasemzimbeni yayixabisekile kwaye ibandakanya izimvo ezichazayo:
“Ndikholelwa ukuba izifundo zokuxilonga umzimba zezona mfundiso zibalaseleyo ngonyango;umzekelo, xa ufundisa ngokwembono yomfundi wesine kunye nesigulane, izixhobo zifanelekile kwaye zomelezwe yinto eyenziwa eklasini.
"I-SPI inikezela ngeengcebiso ezibalaseleyo malunga neendlela ezisebenzayo zokwenza iinkqubo kwaye inikezela ngeengcebiso ezilungileyo kwiimpawu ezinokubangela ukungahambi kakuhle kwizigulane."
“I-SPI ne-MS4 zisebenzisana kakuhle kwaye zibonelela ngombono omtsha wokufundisa oxabiseke kakhulu.I-MS4 ibonelela ngokuqonda kwiinjongo zokufundisa kwindlela yokusebenza kwezonyango.
“Ndingathanda ukuba sidibane rhoqo.Le yeyona ndawo ndiyithandayo kwikhosi yezonyango kwaye ndivakalelwa kukuba iphela ngokukhawuleza. ”
Phakathi kwabaphenduli, i-100% ye-SPI (N=16 [100%]) kunye ne-MS4 (N=44 [77%]) bathi amava abo njengomqeqeshi wePDX alungile;I-91% kunye ne-93%, ngokulandelanayo, ye-SPI kunye ne-MS4s bathi banamava njengomqeqeshi wePDX;amava akhuthazayo okusebenza kunye.
Ucazululo lwethu lomgangatho weempawu zeMS4’s zento abayixabisile kumava abo njengootitshala lube nesiphumo sale mixholo ilandelayo: 1) Ukuphumeza ithiyori yokufunda yabadala: ukukhuthaza abafundi nokudala indawo yokufunda ekhuselekileyo.2) Ukulungiselela ukufundisa: ukucwangcisa isicelo esifanelekileyo seklinikhi, ukulindela imibuzo yabaqeqeshwa, kunye nokusebenzisana ukufumana iimpendulo;3) Ukwenza umzekelo wobuchule;4) Ukugqithisa okulindelekileyo: ukufika kwangoko kunye nokuhamba emva kwexesha;5) Ingxelo: beka phambili ngexesha, impendulo enentsingiselo, eyomeleza neyakhayo;Banike abaqeqeshwayo iingcebiso malunga nemikhwa yokufunda, eyona ndlela ingcono yokugqiba iikhosi zovavanyo lomzimba, kunye neengcebiso ngemisebenzi.
Abafundi abasisiseko bathatha inxaxheba kuviwo lwe-OSCE olunamacandelo amathathu ekupheleni kwesiqingatha sonyaka.Ukuvavanya ukusebenza kwenkqubo yethu, sithelekise ukusebenza kwabafundi abaqeqeshwayo kwicandelo lefiziksi ye-OSCE ngaphambi nasemva kokuqaliswa kwenkqubo ngo-2010. Ngaphambi kowama-2010, ootitshala be-MS4 boogqirha bafundisa iPDX kubafundi abangekabinazidanga.Ngaphandle konyaka wenguqu ka-2010, sithelekise izikhombisi ze-OSCE zasentwasahlobo zezemfundo yezomzimba ngo-2007–2009 kunye nezalathi zika-2011–2014.Inani labafundi abathatha inxaxheba kwi-OSCE lisusela kwi-170 ukuya kwi-185 ngonyaka: Abafundi be-532 kwiqela lokungenelela kwangaphambili kunye nabafundi be-714 kwiqela le-post-intervention.
Amanqaku e-OSCE ukusuka kwi-2007-2009 kunye ne-2011-2014 iimviwo zasentwasahlobo ziyashwankathelwa, zilinganiswe ngobungakanani besampulu yonyaka.Sebenzisa iisampulu ezi-2 ukuthelekisa i-GPA eqokelelweyo yonyaka ngamnye wexesha elidlulileyo kunye ne-GPA eqokelelweyo yexesha lamva usebenzisa uvavanyo lwe-t.I-GW IRB iye yalukhulula olu phononongo yaza yafumana imvume yabafundi ukuba basebenzise ngokungaziwa idatha yabo yezifundo kuphononongo.
Umlinganiselo wecandelo lovavanyo lomzimba unyuke kakhulu ukusuka kwi-83.4 (SD = 7.3, n = 532) ngaphambi kweprogram ukuya kwi-89.9 (SD = 8.6, n = 714) emva kweprogram (intsingiselo yokutshintsha = 6, 5; 95% CI: 5.6 ukuya 7.4; p<0.0001) (Itheyibhile 3).Nangona kunjalo, ekubeni utshintsho olusuka ekufundiseni ukuya kubasebenzi abangafundisiyo luhambelana notshintsho kwikharityhulam, iyantlukwano kumanqaku e-OSCE ayinakucaciswa ngokucacileyo ngokusungula izinto ezintsha.
Imodeli yokufundisa yeqela le-SPI-MS4 yindlela entsha yokufundisa ulwazi lwesiseko somzimba kubafundi bezonyango ukubalungiselela ukuba sesichengeni seklinikhi kwangoko.Oku kubonelela ngenye indlela enempumelelo ngokuphepha imiqobo enxulumene nokuthatha inxaxheba kootitshala.Ikwabonelela ngexabiso elongezelelweyo kwiqela lokufundisa kunye nabafundi babo abasele beqeqeshelwa ngaphambili: bonke bayazuza ngokufunda kunye.Iinzuzo ziquka ukuveza abafundi ngaphambi kokuba baziqhelanise neembono ezahlukeneyo kunye nemizekelo yentsebenziswano [23].Iimbono ezizezinye ezifumaneka kwintsebenziswano yokufunda zidala imeko-bume yonxibelelaniso [10] apho aba bafundi bafumana ulwazi kwimithombo emibini: 1) ikinesthetic - ukwakha iindlela zokuzilolonga ezichanekileyo, i-2) i-synthetic - ukwakha ukucinga ngokuxilonga.Ii-MS4s zikwaxhamla ekufundeni ngentsebenziswano, ukuzilungiselela umsebenzi wexesha elizayo weenkqubo ezahlukeneyo kunye neengcali zempilo ezimanyeneyo.
Imodeli yethu ikwabandakanya izibonelelo zokufunda koontanga [24].Abafundi abaqeqeshelwa kwangaphambili bayazuza kukulungelelaniswa kwengqondo, indawo yokufunda ekhuselekileyo, i-MS4 socialization kunye nomzekelo, kunye "nokufunda kabini" -ukusuka kwimfundo yabo yokuqala kunye neyabanye;Bakwabonisa ukukhula kwabo emsebenzini ngokufundisa oontanga babo abancinci kwaye basebenzise amathuba akhokelwa ngutitshala ukuphuhlisa nokuphucula izakhono zabo zokufundisa neemviwo.Ukongezelela, amava abo okufundisa abalungiselela ukuba babe ngabafundisi abaphumelelayo ngokubaqeqeshela ukusebenzisa iindlela zokufundisa ezisekelwe kubungqina.
Izifundo zafundwa ngexesha lokuphunyezwa kwalo mzekelo.Okokuqala, kubalulekile ukuqonda ukuntsonkotha kobudlelwane phakathi kwe-MS4 kunye ne-SPI, njengoko ezinye iidyad zingenako ukuqonda okucacileyo kweyona ndlela ingcono yokusebenza kunye.Iindima ezicacileyo, iincwadana ezineenkcukacha kunye neendibano zocweyo zamaqela zilungisa le miba ngokufanelekileyo.Okwesibini, uqeqesho oluneenkcukacha kufuneka lubonelelwe ukuze kuphuculwe imisebenzi yeqela.Ngelixa zombini iiseti zabahlohli kufuneka ziqeqeshelwe ukufundisa, iSPI ikwafuna ukuqeqeshwa kwindlela yokwenza izakhono zeemviwo esele izazi kakuhle uMS4.Okwesithathu, ukucwangciswa ngononophelo kuyafuneka ukulungiselela ishedyuli exakekileyo ye-MS4 nokuqinisekisa ukuba iqela lilonke likhoyo kwiseshoni yovavanyo lwezakhiwo nganye.Okwesine, iinkqubo ezintsha zilindeleke ukuba zijongane nokuchaswa kweFaculty kunye nolawulo, kunye neengxoxo ezinamandla ezixhasa ukuphumelela kweendleko;
Isishwankathelo, imodeli yokufundisa ngoxilongo lwe-SPI-MS4 imele ikharityhulamu eyodwa kunye nesebenzayo apho abafundi bezonyango banokufunda ngempumelelo izakhono zomzimba kubantu abangengogqirha abaqeqeshwe ngononophelo.Kuba phantse zonke izikolo zonyango e-United States kunye nezikolo ezininzi zonyango zangaphandle zisebenzisa i-SP, kwaye uninzi lwezikolo zonyango zineenkqubo zabafundi, le modeli inamandla okusetyenziswa ngokubanzi.
Idatha yolu phononongo ifumaneka kuGqr Benjamin Blatt, MD, uMlawuli weZiko loFundo lweGWU.Yonke idatha yethu inikezelwe kuphononongo.
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Ixesha lokuposa: May-11-2024