课程创新:通过以病人为中心的互动式系列教学提高住院医师对门诊神经病学的知识和兴趣

C. Doughty, Galina Gheihman, T. Milligan, Tracey A. Cho
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引用次数: 2

摘要

神经内科住院医师培训以住院病人为重点,忽视门诊疾病。我们在病人和门诊神经科医生之间实施了一系列促进讨论的新型教学,让住院医生了解门诊话题和管理技巧。(1)提高住院医生对门诊神经科医生的角色和责任的理解;(2)与住院医师分享患者对慢性神经系统疾病生活的看法;(3)提高居民对有效共享决策的理解。一个学术神经学项目的住院医师参与了研究。2016年,我们亲自进行了6次每两个月一次、每次1小时的培训;每次会议结束后都会对参与者进行调查,以改进形式。正式课程(6期)于2020-2021年进行虚拟课程。每次会议集中讨论一种障碍。课程的形式是对话式的,由课程主任主持。讨论点是预先计划好的,重点是慢性神经疾病患者的生活经历和共同决策。在2020-2021年系列结束时,对住院医生、参与的教师和患者进行了调查,以评估其有效性。在试点期间,居民完成了55份调查问卷。只有12名住院医生(22%)表示他们纵向随访了1名以上的患者。来自住院医生和教师的定性评论(n = 5)表明,倾听患者的观点是该系列中最有价值的组成部分。54位居民中有21位对最终方案进行了评估。大多数住院医师、100%的教师(n = 6)和100%的患者(n = 6)认为该计划的3个学习目标得到了满足。48%的住院医生表示,他们对门诊工作的兴趣有所增加。教师们一致认为,这种授课形式与传统讲座一样有效,而且没有增加准备工作的负担。患者认为分享他们的经历可以帮助医生更好地了解他们的疾病,并改善对未来患者的护理;所有人都会再次参加。我们的系列有效地教育了住院医师关于未被充分代表的门诊话题。倾听患者的观点有助于我们实现学习目标。成功实施的关键因素包括教师主持人,预先计划的问题,以及强调重点学习点的教学幻灯片。未来的工作应该评估居民增加的知识和兴趣是否转化为持续的行为改变和更多的居民选择门诊职业。
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Curriculum Innovations: Improving Residents' Knowledge and Interest in Outpatient Neurology Through an Interactive Patient-Centered Didactic Series
Neurology residency training is inpatient focused, underemphasizing outpatient disorders. We implemented a novel didactic series of facilitated discussions between a patient and their outpatient neurologist to expose residents to outpatient topics and management skills.(1) Improve residents' understanding of the roles and responsibilities of the neurologist in the outpatient setting; (2) share with residents the patient's perspective of living with chronic neurologic disease; and (3) improve residents' understanding of what effective shared decision making entails.Residents in an academic neurology program participated. Six bimonthly, 1-hour sessions were piloted in person in 2016; participants were surveyed after each session to refine the format. The formal program (6 sessions) was held virtually in 2020–2021. Each session focused on 1 disorder. The format was conversational and moderated by a course director. Discussion points were preplanned and focused on patients' experiences living with chronic neurologic disease and shared decision making. Residents, participating faculty, and patients were surveyed at the conclusion of the 2020–2021 series to evaluate its effectiveness.Fifty-five survey responses were completed by residents during the pilot. Only 12 residents (22%) indicated that they longitudinally followed more than 1 patient with the condition represented in the session. Qualitative comments from residents and faculty (n = 5) identified that hearing the patient perspective was the most valuable component of the series. Twenty-one of 54 residents evaluated the final program. A majority of residents, 100% of faculty (n = 6), and 100% of patients (n = 6) felt that the program's 3 learning objectives were met. Forty-eight percent of residents reported increased interest in outpatient careers. Faculty agreed that the session format was as effective as traditional lecture, without added preparation burden. Patients felt that sharing their experiences would help physicians better understand their illness and improve care for future patients; all would participate again.Our series effectively educated residents about underrepresented outpatient topics. Hearing patients' perspectives was instrumental in achieving our learning objectives. Key factors for successful implementation included a faculty moderator, preplanned questions, and teaching slides to emphasize key learning points. Future work should evaluate whether residents' increased knowledge and interest translates into sustained behavior change and more residents selecting outpatient careers.
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