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Voices of the Future: Junior Physicians' Experiences of Discussing Life-Sustaining Treatments With Hospitalized Patients. 未来之声:初级医生与住院病人讨论维持生命治疗的经验。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241277334
Michael Andreas Müller, Claudia Gamondi, Eve Rubli Truchard, Anca-Cristina Sterie

Objectives: Life-sustaining treatments (LST) aim to prolong life without reversing the underlying medical condition. Being associated with a high risk of developing unwanted adverse outcomes, decisions about LST are routinely discussed with patients at hospital admission, particularly when it comes to cardiopulmonary resuscitation. Physicians may encounter many challenges when enforcing shared decision-making in this domain. In this study, we map out how junior physicians in Southern Switzerland refer to their experiences when conducting LST discussions with hospitalized patients and their learning strategies related to this.

Methods: In this qualitative exploratory study, we conducted semi-directive interviews with junior physicians working at the regional public hospital in Southern Switzerland and analyzed them with an inductive thematic analysis.

Results: Nine physicians participated. We identified 3 themes: emotional burden, learning strategies and practices for conducting discussions. Participants reported feeling unprepared and often distressed when discussing LST with patients. Factors associated with emotional burden were related to the context and to how physicians developed and managed their emotions. Participants signaled having received insufficient education to prepare for discussing LST. They reported learning to discuss LST essentially through trial and error but particularly appreciated the possibility of mentoring and experiential training. Explanations that physicians gave about LST took into account patients' frequent misconceptions. Physicians reported feeling under pressure to ensure that decisions documented were medically indicated and being more at ease when patients decided by themselves to limit treatments. Communication was deemed as an important skill.

Conclusions: Junior physicians experienced conducting LST discussions as challenging and felt caught between advocating for medically relevant decisions and respecting patients' autonomy. Participants reported a substantive emotional burden and feeling unprepared for this task, essentially because of a lack of adequate training. Interventions aiming to ameliorate junior physicians' competency in discussing LST can positively affect their personal experiences and decisional outcomes.

目标:维持生命治疗(LST)旨在延长生命而不逆转潜在的病情。由于维持生命治疗与出现意外不良后果的高风险相关,因此在患者入院时,尤其是在心肺复苏时,需要与患者讨论有关维持生命治疗的决策。医生在这一领域执行共同决策时可能会遇到许多挑战。在这项研究中,我们描绘了瑞士南部的初级医师在与住院患者进行 LST 讨论时如何参考他们的经验,以及他们与此相关的学习策略:在这项定性探索性研究中,我们对在瑞士南部地区公立医院工作的初级医师进行了半定向访谈,并通过归纳主题分析法对访谈内容进行了分析:九名医生参加了访谈。我们确定了 3 个主题:情绪负担、学习策略和开展讨论的实践。参与者表示,在与患者讨论 LST 时,他们感到毫无准备,而且经常感到痛苦。与情绪负担相关的因素与环境以及医生如何培养和管理自己的情绪有关。参与者表示没有接受过足够的教育来为讨论 LST 做好准备。他们表示基本上是通过反复试验才学会讨论 LST 的,但他们特别希望能够得到指导和体验式培训。医生对 LST 的解释考虑到了患者经常出现的误解。医生报告说,他们感到压力很大,必须确保记录在案的决定是有医学根据的,而当病人自己决定限制治疗时,他们会更放心。沟通被视为一项重要技能:初级医师认为进行 LST 讨论具有挑战性,并在倡导医学相关决定和尊重患者自主权之间感到为难。参与者报告说,由于缺乏足够的培训,他们承受着巨大的精神负担,并感觉没有做好准备。旨在提高初级医生讨论 LST 能力的干预措施可对他们的个人经历和决策结果产生积极影响。
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引用次数: 0
Evaluating Outcomes of a Co-Produced Theatre-Based Experiential Learning Project in Psychiatry. 评估共同制作的基于戏剧的精神病学体验式学习项目的成果。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241278175
Thomas Walker, Tomos Jones, Hugh Grant-Peterkin, Rupal Dave, Frank Röhricht

Introduction: The benefits of theatre and arts-based initiatives for enhancing the health and wellbeing of adults, regardless of mental health status, are well-documented. Theatre methodologies offer a platform for co-produced experiential learning, promoting perspective-taking and effective communication among staff and service users. This project aimed to bring together service users and mental health professionals through workshops conducted by an experiential theatre company, focusing on themes such as relationship dynamics, co-production, empowerment and perspective-taking. Notably, the sessions were conducted online due to the COVID-19 pandemic.

Methods: The study sought to explore the experiences, learning outcomes and work-related wellbeing benefits of participating in this innovative project. Methods involved inviting East London Foundation Trust members to eight weekly online workshops, culminating in a co-created filmed performance. Interviews conducted 9 months to a year later with participants and facilitators were thematically analysed.

Results: Results revealed four key themes: (1) personal and collective growth through storytelling and embodied acting experiences; (2) the importance of workshop structure for experiential learning; (3) challenging traditional role definitions through diminished hierarchy; and (4) sustained impacts on time management at work and in personal lives.

Conclusions: In conclusion, participants valued their involvement, indicating that theatre-based co-produced learning enhances communication and interpersonal skills in mental healthcare settings. These findings suggest the potential for integrating such approaches into healthcare education and training programs.

简介无论精神健康状况如何,戏剧和以艺术为基础的活动对提高成年人的健康和福祉都有很好的益处。戏剧方法为共同制作的体验式学习提供了一个平台,促进了员工和服务使用者之间的视角转换和有效沟通。本项目旨在通过由体验式剧团举办的研讨会,将服务使用者和心理健康专业人员聚集在一起,重点关注关系动态、共同制作、赋权和透视等主题。值得注意的是,由于 COVID-19 的流行,这些会议都是在网上进行的:研究旨在探讨参与这一创新项目的经历、学习成果以及与工作相关的福利。研究方法包括邀请东伦敦基金会信托基金的成员参加每周八次的在线研讨会,最后共同制作一个视频表演。9 个月至一年后,对参与者和主持人进行了访谈,并对访谈结果进行了主题分析:结果揭示了四个关键主题:(1) 通过讲故事和表演体验实现个人和集体成长;(2) 工作坊结构对体验式学习的重要性;(3) 通过减少等级制度挑战传统角色定义;(4) 对工作和个人生活中的时间管理产生持续影响:总之,参与者非常重视他们的参与,这表明以戏剧为基础的共同制作学习能增强心理保健环境中的沟通和人际交往技能。这些研究结果表明,将此类方法融入医疗保健教育和培训项目中大有可为。
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引用次数: 0
From Dilemma to Denouement: Using Literary Techniques to Understand Conflict in Medical Education. 从困境到结局:运用文学技巧理解医学教育中的冲突。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241279064
Beatrice T B Preti
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引用次数: 0
Effectiveness of Distance Training Based on Simple Triage and Quick Treatment System (START) Triage System in Pre-Hospital Emergency. 基于简单分诊和快速治疗系统(START)分诊系统的远程培训在院前急救中的效果。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241278658
Mofid Hosseinzadeh, Ali-Vafagh Nematollahi, Yasin Afra, Payam Amini, Alireza Rafati Navaei

Objective: Triage is the key to success in managing many injured people with limited resources. Therefore, triage training for crisis team medical staff is critical. This study aimed to evaluate the effectiveness of asynchronous learning on immediate care personnel based on the Simple Triage and Quick Treatment System (START) triage system.

Methods: In this quasi-experimental study, asynchronous learning based on the START triage system was performed on the immediate care staff of Ahvaz Jundishapur University of Medical Sciences from February 2021 to December 2021. Sixty pre-hospital emergency medical staff were randomly assigned to intervention and control groups. Intervention group participants were provided an asynchronous digital training module, and control group participants received the usual training. Data were collected in both groups as pre-test and post-test with demographic information and knowledge assessment questionnaires.

Results: Distance triage training based on the START triage system has a significant effect on the level of awareness of the need for triage and knowledge (awareness) and performance (individual efficiency) of immediate care in the intervention group compared to before training (P < 0.001).

Conclusion: Considering the positive results of the pre-organizing model on raising the level of awareness of immediate care personnel, the use of this training method in triage in emergency medicine and retraining workshops could be considered.

目的:分诊是在资源有限的情况下成功救治众多伤员的关键。因此,危机处理小组医务人员的分诊培训至关重要。本研究旨在评估基于简单分诊和快速治疗系统(START)分诊系统的异步学习对即时护理人员的效果:在这项准实验研究中,2021 年 2 月至 2021 年 12 月期间,对阿瓦士君迪沙普尔医科大学的急救人员进行了基于 START 分诊系统的异步学习。60 名院前急救人员被随机分配到干预组和对照组。干预组参与者接受异步数字培训模块,对照组参与者接受常规培训。两组的数据均以人口统计学信息和知识评估问卷的形式进行前测和后测:结果:与培训前相比,基于 START 分诊系统的远程分诊培训对干预组的分诊需求意识水平、即时护理知识(意识)和绩效(个人效率)有显著影响(P考虑到预组织模式在提高即时护理人员意识水平方面的积极效果,可以考虑在急诊医学分诊和再培训讲习班中使用这种培训方法。
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引用次数: 0
Reforming Medical Physics and Radiopharmaceutical Science Training Through a Programmatic Approach to Assessment. 通过评估计划改革医学物理和放射性药物科学培训。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241271539
Kristy C Osborne, Cathryn Barbagallo, Ammar Aldaoud, Jennifer Guille, Andrew Campbell, Megan Anderson, Jacob Pearce

Objectives: Programmatic assessment approaches can be extended to the design of allied health professions training, to enhance the learning of trainees. The Australasian College of Physical Scientists and Engineers in Medicine worked with assessment specialists at the Australian Council for Educational Research and Amplexa Consulting, to revise their medical physics and radiopharmaceutical science training programs. One of the central aims of the revisions was to produce a training program that provides standardized training support to their registrars throughout the 3 years, better supporting their registrars to successfully complete the program in the time frame through providing timely and constructive feedback on the registrar's progression.

Methods: We used the principles of programmatic assessment to revise the assessment methods and progression decisions in the three training programs.

Results: We revised the 3-year training programs for diagnostic imaging medical physics, radiation oncology medical physics and radiopharmaceutical science in Australia and New Zealand, incorporating clear stages of training and associated progression points.

Conclusions: We discuss the advantages and difficulties that have arisen with this implementation. We found 5 key elements necessary for implementing programmatic assessment in these specialized contexts: embracing blurred boundaries between assessment of and for learning, adapting the approach to each specialized context, change management, engaging subject matter experts, and clear communication to registrars/trainees.

目标:可将计划评估方法推广到联合健康专业培训的设计中,以提高学员的学习效果。澳大利亚医学物理科学家和工程师学院与澳大利亚教育研究委员会和 Amplexa 咨询公司的评估专家合作,对其医学物理和放射性药物科学培训计划进行了修订。修订的核心目标之一是制定一项培训计划,为注册医师提供为期 3 年的标准化培训支持,通过对注册医师的进展情况提供及时和建设性的反馈,更好地支持注册医师在规定时间内顺利完成培训计划:方法:我们运用项目评估原则,修订了三个培训项目的评估方法和进度决定:结果:我们修订了澳大利亚和新西兰的影像诊断医学物理学、肿瘤放射医学物理学和放射性药物学三年培训计划,纳入了明确的培训阶段和相关的进修点:结论:我们讨论了实施该计划的优势和困难。我们发现,在这些专业背景下实施项目评估需要具备 5 个关键要素:接受学习评估和学习评估之间模糊的界限、根据每个专业背景调整方法、变革管理、让主题专家参与进来以及与注册人员/学员进行清晰的沟通。
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引用次数: 0
Development of a Canadian Medical Assistance in Dying Curriculum for Healthcare Providers. 为医疗服务提供者开发加拿大临终医疗协助课程。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-08-31 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241272376
Gilla K Shapiro, Kate Hunt, Heather Braund, Nancy Dalgarno, Aliza A Panjwani, Sarah Stevens, Jeanne Mulder, Madurika S Sheth, Alison Stere, Stefanie Green, Gord Gubitz, Madeline Li

Objectives: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016, necessitating greater education and training in MAiD for physicians and nurse practitioners. To meet this need, the Canadian MAiD Curriculum (CMC) was developed to offer a nationally accredited, comprehensive, bilingual, hybrid (synchronous and asynchronous) educational program to support and enhance the practice of MAiD in Canada.

Methods: This work describes the process of developing the CMC, including its guiding principles and framework. The CMC was guided by constructivism and adult learning theory, preliminary literature review, 5 key principles based on a needs assessment survey, as well as consultation with diverse partners.

Results: Seven modules were developed: (1) foundations of MAiD in Canada, (2) clinical conversations that includes MAiD, (3) how to do an MAiD assessment, (4) capacity and vulnerability, (5) providing MAiD, (6) navigating complex cases with confidence, and (7) MAiD and mental disorders. An eighth topic on clinician resilience and reflection was woven into each of the 7 modules.

Conclusion: This curriculum ensures that consistent information is available to healthcare providers concerning the practice of MAiD in Canada. To ensure sustainability, the CMC will continue to be updated alongside the evolution of MAiD policy and services in Canada.

目的:加拿大于2016年将临终医疗协助(MAiD)合法化,因此有必要加强对医生和执业护士的临终医疗协助教育和培训。为满足这一需求,加拿大开发了加拿大临终医疗协助课程(Canadian MAiD Curriculum,CMC),提供国家认可的、全面的、双语的混合(同步和异步)教育课程,以支持和加强加拿大的临终医疗协助实践:方法:本文介绍了加拿大多媒体中心的开发过程,包括其指导原则和框架。CMC 以建构主义和成人学习理论、初步文献综述、基于需求评估调查的 5 项关键原则以及与不同合作伙伴的磋商为指导:开发了七个模块:(1) 加拿大多元文化心理发展的基础,(2) 包括多元文化心理发展在内的临床对话,(3) 如何进行多元文化心理发展评估,(4) 能力与脆弱性,(5) 提供多元文化心理发展,(6) 自信地处理复杂病例,(7) 多元文化心理发展与精神障碍。在这 7 个模块中,每个模块都包含了关于临床医生应变能力和反思的第八个主题:该课程确保为加拿大的医疗服务提供者提供有关精神创伤和痛苦实践的一致信息。为确保可持续发展,CMC 将随着加拿大 MAiD 政策和服务的发展而不断更新。
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引用次数: 0
Resources Exist to Integrate Nutrition into Graduate Medical Education. 将营养学纳入医学研究生教育的资源是存在的。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-08-31 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241264699
Elizabeth Pegg Frates
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引用次数: 0
A Retrospective Cohort Analysis Comparing Analytic and Holistic Marking Rubrics in Medical Research Education. 一项回顾性队列分析,比较医学研究教育中的分析性和整体性评分标准。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-08-28 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241277337
Siew Wan Yeo, Christina Signorelli, Khanh Vo, Greg Smith

Objectives: The use of analytic rubrics in assessing and grading students' performance has become more prominent among instructors due to its reliability and validity in ensuring consistency in student evaluation. However, there is limited evidence demonstrating the consistency of examiner judgments between analytic marking rubrics and holistic marking rubrics.

Methods: Therefore, we aimed to compare the consistency of marks given using holistic marking methods and analytic rubrics at an Australian university by analyzing the mean mark differences and number of adjudications between two rubric types as well as the inter-rater reliability between two assessors. We analyzed all scores for project manuscripts between 2016 and 2021 for Honours medical students. We compared the mean mark differences graded using the Kruskal-Wallis test and Welch t-test. We used chi-squared tests to compare the frequency of adjudications for each rubric type. We assessed interrater reliability by comparing the marks between the two examiners utilizing Pearson correlation.

Results: We found that analytic rubrics have lower mean mark differences and fewer adjudicators are required. We showed a strong positive association between the consistency of marks given and the use of analytic rubrics when compared to holistic marking. Pearson correlation showed a low but stronger correlation between marks awarded by the two assessors when analytic rubrics were used (r = 0.36), compared to holistic marking rubrics (r = 0.24).

Conclusions: Our findings suggest that the use of analytic rubrics may increase the consistency and reliability between two independent examiners in marking medical students' work.

目的:由于分析评分标准在确保学生评价的一致性方面具有可靠性和有效性,因此在评估和给学生成绩打分时使用分析评分标准在教师中越来越受到重视。然而,能证明分析评分标准与整体评分标准之间考官判断一致性的证据却很有限:因此,我们旨在通过分析两种评分标准之间的平均分数差异和判定次数,以及两名评审员之间的互评可靠性,比较澳大利亚一所大学使用整体评分法和分析评分标准给出的分数的一致性。我们分析了 2016 年至 2021 年期间医学荣誉生项目手稿的所有评分。我们使用 Kruskal-Wallis 检验和 Welch t 检验比较了平均分数差异。我们使用卡方检验比较了每种评分标准类型的判定频率。我们利用皮尔逊相关法比较了两位考官的评分,从而评估了考官间的可靠性:结果:我们发现,分析评分标准的平均分数差异较小,需要的评审员也较少。与整体评分相比,我们发现评分的一致性与分析性评分标准的使用之间有很强的正相关性。皮尔逊相关性显示,与整体评分标准(r = 0.24)相比,使用分析评分标准(r = 0.36)时,两位评委给出的分数之间的相关性较低,但更强:我们的研究结果表明,使用分析评分标准可以提高两名独立考官在评阅医学生作业时的一致性和可靠性。
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引用次数: 0
Beyond the Books: COVID-19's Influence on Future Life Behaviors of Aspiring Medical and Health Professionals. 书本之外:COVID-19 对有抱负的医疗卫生专业人员未来生活行为的影响。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241272357
Zheng Gong, Joseph Adu-Amankwaah, Lu Fu, Weili Qiao, Wen Li, Hongjian Hou, Tongtong Ma, Mingyu He, Teodora A Cubelo, Hong Sun

Background: The lifestyle of most people was forced to change due to the COVID-19 pandemic. Perhaps after the pandemic, we will find that these subtle changes in life and from the depths of our hearts are thorough and profound. They may form our conceptual consensus and behavioral habits, becoming part of our long-term personal consciousness. This study explored the impacts of the COVID-19 pandemic on the future life behavior intentions of medical and health-related students studying at universities in China.

Methods: Electronic questionnaires were distributed to students studying at 3 universities in China. A total of 251 valid questionnaires were obtained, and the chi-squared test was used to compare the corresponding groups.

Results: In the future, students plan to pay more attention to wearing masks and maintaining social distance in public places, do more online shopping, have more meals at home or in the canteen, engage in less international travel, and have fewer gatherings with friends. However, compared with Chinese students, more non-Chinese students plan to increase domestic and international travel and reduce online learning. Furthermore, only among non-Chinese students did gender, urban or rural origin, and family economic conditions influence how the COVID-19 pandemic affected their future life behaviors.

Conclusion: The COVID-19 pandemic changed the future life behavior intentions of medical and health-related students. The future behaviors of these students will impact the entire society. This study will help the government and policymakers predict and prepare for general lifestyle changes in our society.

背景:由于 COVID-19 大流行,大多数人的生活方式被迫改变。也许在大流行之后,我们会发现这些生活中和来自内心深处的细微变化是彻底而深刻的。它们可能会形成我们的观念共识和行为习惯,成为我们长期个人意识的一部分。本研究探讨了 COVID-19 大流行对中国高校医学和健康相关专业学生未来生活行为意向的影响:方法:向中国 3 所大学的在校学生发放电子问卷。方法:向中国 3 所大学的在校学生发放电子问卷,共获得 251 份有效问卷,并采用卡方检验对相应组别进行比较:结果:学生们计划今后在公共场所更加注意戴口罩和保持社交距离,更多地进行网上购物,更多地在家里或食堂就餐,减少出国旅行,减少与朋友的聚会。然而,与中国学生相比,更多的非中国学生计划增加国内和国际旅行,减少网上学习。此外,只有在非中国学生中,性别、城市或农村出身以及家庭经济条件才会影响 COVID-19 大流行对他们未来生活行为的影响:结论:COVID-19 大流行改变了医学和健康相关专业学生的未来生活行为意向。这些学生的未来行为将影响整个社会。这项研究将有助于政府和政策制定者预测社会生活方式的总体变化并为之做好准备。
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引用次数: 0
Impact of Psychiatry Posting on Attitudes Toward Mental Illness: A Prospective Cohort Study of Medical Students From Three Universities. 精神病学张贴对精神疾病态度的影响:三所大学医学生的前瞻性队列研究》。
IF 2 Q2 EDUCATION, SCIENTIFIC DISCIPLINES Pub Date : 2024-08-19 eCollection Date: 2024-01-01 DOI: 10.1177/23821205241275420
Oluyemi O Akanni, Imesidayo O Eboreime-Oikeh, Oderinde K Oyeyemi, Anthony A Olashore

Introduction: Negative attitudes towards mental illness are known to exist among medical students in Nigeria. However, the effect of undergoing a rotation in psychiatry on their attitudes is uncertain.

Objectives: It aimed to determine the effect of psychiatry posting during medical training on medical students' attitudes toward mental illness and examine the association of posting-related and demographic factors with their attitudes.

Methods: It is a prospective cohort study in which 187 medical students from three different universities were followed up during their psychiatry postings in two different posting sites. Questionnaires containing basic demography, posting-related variables, and the Community Attitude to Mental Illness (CAMI) scale were administered to all available students before and after the rotation in psychiatry. A paired t-test was applied to test the differences in the CAMI scores before and after posting, while ANOVA and hierarchical regression were utilized to determine the association of variables with the CAMI scores.

Results: There were significant differences between the pre-and post-rotation CAMI scores in CAMI's social restrictiveness (SR) and community mental health ideology (CMHI) domains, indicating improved attitudes. Demographic factors had no significant influence on the students' attitudes, but the length of posting, university of the students, and posting sites had varying impacts.

Conclusion: Psychiatry rotation has a positive impact on students' attitudes toward mental illness in both posting sites, particularly in the domains of SR and CMHI. This underscores the importance of psychiatry training in medical education in changing the attitudes of future healthcare professionals.

导言:众所周知,尼日利亚的医科学生对精神疾病持消极态度。然而,精神科轮转对他们态度的影响尚不确定:方法:这是一项前瞻性队列研究:这是一项前瞻性队列研究,对来自三所不同大学的 187 名医科学生在两个不同派驻点进行精神科派驻期间的情况进行了跟踪调查。在精神科轮转之前和之后,对所有学生进行了问卷调查,内容包括基本人口统计学、岗位相关变量和社区对精神疾病的态度量表(CAMI)。采用配对 t 检验来检验轮岗前后 CAMI 分数的差异,同时采用方差分析和层次回归来确定变量与 CAMI 分数之间的关联:在 CAMI 的社会限制性(SR)和社区心理健康意识形态(CMHI)领域,张贴前和张贴后的 CAMI 分数存在明显差异,这表明受访者的态度有所改善。人口统计学因素对学生的态度没有明显影响,但发布时间的长短、学生所在的大学和发布地点则有不同程度的影响:精神病学轮转对两个派驻地点的学生对精神疾病的态度都有积极影响,尤其是在 SR 和 CMHI 领域。这强调了医学教育中精神病学培训对改变未来医护人员态度的重要性。
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引用次数: 0
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Journal of Medical Education and Curricular Development
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