ʻO ka mea maʻamau, ua aʻo nā mea hoʻonaʻauao i ka hoʻokolohua kino (PE) i nā poʻe hou mai ka lāʻau lapaʻau (nā mea aʻo), ʻoiai nā pilikia me ka hoʻolimalima ʻana a me nā kumukūʻai, a me nā pilikia me nā ʻenehana maʻamau.
Hāʻawi mākou i kahi kumu hoʻohālike e hoʻohana ana i nā hui kumu o nā kumu hoʻomanawanui (SPI) a me nā haumāna lapaʻau makahiki ʻehā (MS4s) e aʻo i nā papa hoʻonaʻauao kino i nā haumāna premedical, me ka hoʻohana piha ʻana i ke aʻo ʻana a me nā hoa kōkua.
Ua hōʻike nā noiʻi o nā haumāna ma mua o ka lawelawe, MS4 a me SPI i nā manaʻo maikaʻi o ka papahana, me nā haumāna MS4 e hōʻike ana i nā hoʻomaikaʻi koʻikoʻi i ko lākou ʻano ʻoihana ma ke ʻano he kumu.Ua like a ʻoi aku ka maikaʻi o ka hana a nā haumāna ma mua o ka hoʻomaʻamaʻa ʻana i nā hoʻokolohua loea lapaʻau ma mua o kā lākou mau hoa hana.
Hiki i ka hui SPI-MS4 ke aʻo maikaʻi i nā haumāna novice i ka mechanics a me ke kumu lapaʻau o ka hoʻokolohua kino novice.
Aʻo nā haumāna lapaʻau hou (nā haumāna mua o ka lāʻau lapaʻau) i ka hoʻokolohua kino kino (PE) ma ka hoʻomaka ʻana o ke kula olakino.E mālama i nā papa hoʻonaʻauao kino no nā haumāna kula hoʻomākaukau.ʻO ka mea maʻamau, ʻo ka hoʻohana ʻana i nā kumu aʻo he mau hemahema, ʻo ia hoʻi: 1) pipiʻi;3) paʻakikī lākou e hoʻopaʻa inoa;4) paʻakikī lākou e hoʻohālikelike;5) hiki ke ala mai nā nuances;nā hewa i ʻike ʻole ʻia [1, 2] 6) ʻAʻole paha i kamaʻāina i nā ʻano aʻo e pili ana i ka hōʻike ʻana [3] 7) Manaʻo paha ʻaʻole lawa nā mākaukau aʻo hoʻonaʻauao kino [4];
Ua hoʻomohala ʻia nā ʻano hoʻohālike hoʻomaʻamaʻa kūleʻa me ka hoʻohana ʻana i nā maʻi maoli [5], nā haumāna lapaʻau kiʻekiʻe a i ʻole kamaʻāina [6, 7], a me nā poʻe kamaʻāina [8] ma ke ʻano he kumu.He mea nui e hoʻomaopopo i ka like o kēia mau hiʻohiʻona a pau ʻaʻole i emi ka hana a nā haumāna ma nā haʻawina hoʻonaʻauao kino ma muli o ka haʻalele ʻana o ke kumu komo [5, 7].Eia nō naʻe, ʻaʻohe ʻike o ka poʻe hoʻonaʻauao ma ka pōʻaiapili lapaʻau [9], he mea koʻikoʻi no nā haumāna e hiki ke hoʻohana i ka ʻikepili haʻuki e hoʻāʻo ai i nā kuhiakau diagnostics.No ka hoʻoponopono ʻana i ka pono o ka hoʻomaʻamaʻa ʻana a me kahi pōʻaiapili i ke aʻo ʻana i ke kino, ua hoʻohui kekahi pūʻulu kumu i nā hana diagnostic i alakaʻi ʻia i ka hypothesis i kā lākou aʻo ʻana [10].Ma ke Kula Lapaʻau o George Washington University (GWU), ke kamaʻilio nei mākou i kēia pono ma o ke kumu hoʻohālike o nā pūʻulu hoʻonaʻauao maʻi (SPI) a me nā haumāna lapaʻau kiʻekiʻe (MS4s).(Figure 1) Hoʻopili ʻia ʻo SPI me MS4 e aʻo i ka PE i nā haumāna.Hāʻawi ʻo SPI i ka ʻike i ka mīkini o ka hoʻokolokolo MS4 ma kahi pōʻaiapili.Ke hoʻohana nei kēia kükohu i ke aʻo like ʻana, ʻo ia ka mea hana ikaika aʻo [11].No ka mea, hoʻohana ʻia ʻo SP ma kahi kokoke i nā kula lapaʻau US a me nā kula honua he nui [12, 13], a he nui nā kula lapaʻau i loaʻa nā papahana haumāna-kumu, hiki i kēia kumu hoʻohālike ke noi ākea.ʻO ke kumu o kēia ʻatikala e wehewehe i kēia hiʻohiʻona hoʻomaʻamaʻa haʻuki hui SPI-MS4 (Figure 1).
ʻO ka wehewehe pōkole o ke kumu hoʻonaʻauao hui like ʻo MS4-SPI.MS4: Haumāna Lapaʻau Makahiki ʻEhā SPI: Hoʻonaʻauao maʻi maʻamau;
ʻO ka hōʻailona kino i koi ʻia (PDX) ma GWU kekahi ʻāpana o ka papa mākaukau lapaʻau ma mua o ke kākau ʻōlelo ma ka lāʻau lapaʻau.Nā mea'ē aʻe: 1) Hoʻohui clinical (nā hui pūʻulu e pili ana i ke kumu PBL);2) Nīnauele;3) Nā hana formative OSCE;4) Hoʻomaʻamaʻa hoʻomaʻamaʻa (hoʻohana ʻana i nā mākau lapaʻau e nā kauka hoʻomaʻamaʻa);5) Ke aʻo ʻana no ka hoʻomohala ʻoihana;Hana ʻo PDX i nā pūʻulu o 4-5 mau mea aʻo e hana ana ma ka hui SPI-MS4 hoʻokahi, hālāwai 6 manawa i ka makahiki no 3 mau hola i kēlā me kēia.ʻO ka nui o ka papa ma kahi o 180 mau haumāna, a i kēlā me kēia makahiki ma waena o 60 a me 90 MS4 haumāna i koho ʻia i kumu no nā papa PDX.
Loaʻa iā MS4 ka hoʻomaʻamaʻa kumu ma o kā mākou TALKS (Teaching Knowledge and Skills) elective kumu aʻoaʻo, e pili ana i nā haʻawina e pili ana i nā kumu aʻo makua, nā mākau aʻo, a me ka hāʻawi ʻana i nā manaʻo [14].Loaʻa nā SPI i kahi papahana hoʻomaʻamaʻa lōʻihi i hoʻomohala ʻia e kā mākou CLASS Simulation Center Assistant Luna (JO).Hoʻonohonoho ʻia nā papa SP e pili ana i nā alakaʻi i kūkulu ʻia e nā kumu e pili ana i nā loina o ke aʻo ʻana o nā mākua, nā ʻano aʻo, a me ke alakaʻi a me ka hoʻoikaika pūʻulu.ʻO ke kikoʻī, hoʻomaʻamaʻa ʻia ka SPI a me ka hoʻomaʻamaʻa ʻana i nā ʻano he nui, e hoʻomaka ana i ke kauwela a hoʻomau i ka makahiki kula.Aia nā haʻawina pehea e aʻo ai, kamaʻilio a alakaʻi i nā papa;pehea e pili ai ka haʻawina i ke koena o ka papa;pehea e hāʻawi ai i nā manaʻo;pehea e hana ai i na hooikaika kino a ao aku i na haumana.No ka loiloi ʻana i ka mākaukau no ka papahana, pono nā SPI e hele i kahi hoʻokolohua hoʻonohonoho i mālama ʻia e ka lālā kumu SP.
Ua komo pū ʻo MS4 a me SPI i kahi papa hana hui ʻelua hola e wehewehe i kā lākou kuleana koʻikoʻi i ka hoʻolālā a hoʻokō ʻana i ka haʻawina a me ka loiloi ʻana i nā haumāna e komo ana i ka hoʻomaʻamaʻa mua.ʻO ke kumu kumu o ka papa hana ʻo ia ke kumu hoʻohālike GRPI (nā pahu hopu, nā kuleana, nā kaʻina hana a me nā mea interpersonal) a me Mezirow's theory of transformational learning (ka hana, nā wahi a me nā ʻike) no ke aʻo ʻana i nā manaʻo aʻo interdisciplinary (hoʻohui) [15, 16].ʻO ka hana pū ʻana ma ke ʻano he kumu-kumu e kūlike me nā manaʻo aʻo pilikanaka a me ka ʻike: ua hana ʻia ke aʻo ʻana ma nā hoʻololi pilikino ma waena o nā lālā o ka hui [17].
Hoʻonohonoho ʻia ka haʻawina PDX a puni ke kumu hoʻohālike ʻo Core and Clusters (C+C) [18] no ke aʻo ʻana i ka PE ma ke ʻano o ka noʻonoʻo lapaʻau ma luna o 18 mahina, me ka papa kuhikuhi o kēlā me kēia puʻupuʻu i kālele ʻia i nā hōʻike maʻi maʻamau.E aʻo mua nā haumāna i ka māhele mua o C+C, he hoʻokolohua kaʻa kaʻa he 40 nīnau e uhi ana i nā ʻōnaehana kino nui.ʻO ka hōʻike kumu he hoʻokolohua kino maʻalahi a maʻalahi hoʻi i ʻoi aku ka liʻiliʻi o ka ʻauhau ma mua o ka hoʻokolokolo maʻamau.He kūpono nā hoʻokolohua kumu no ka hoʻomākaukau ʻana i nā haumāna no ka ʻike lapaʻau mua a ua ʻae ʻia e nā kula he nui.A laila neʻe nā haumāna i ka ʻāpana ʻelua o C+C, ka Diagnostic Cluster, ʻo ia kahi hui o nā H&P i alakaʻi ʻia i ke kuhiakau i hoʻonohonoho ʻia a puni nā hōʻike hōʻike lapaʻau maʻamau i hoʻolālā ʻia e hoʻomohala i nā mākau noʻonoʻo.ʻO ka ʻeha o ka umauma he laʻana o ia ʻano hōʻike maʻi (Table 1).Wehe nā pūʻulu i nā hana koʻikoʻi mai ka hoʻokolokolo mua (e laʻa, ka auscultation cardiac maʻamau) a hoʻohui i nā hana kūikawā hou e kōkua i ka hoʻokaʻawale ʻana i ka hiki ke diagnostic (e laʻa, ka hoʻolohe ʻana i nā kani hou o ka naʻau ma ke kūlana decubitus lateral).Aʻo ʻia ʻo C+C ma kahi o 18 mau mahina a hoʻomau ʻia ka haʻawina, me ka hoʻomaʻamaʻa mua ʻia ʻana o nā haumāna ma kahi o 40 mau hoʻokolohua kaʻa nui, a laila, i ka wā e mākaukau ai, neʻe i nā hui, e hōʻike ana kēlā me kēia i kahi hana lapaʻau e hōʻike ana i kahi ʻōnaehana ʻōnaehana.nā ʻike o ka haumāna (e laʻa, ka ʻeha o ka umauma a me ka pōkole o ka hanu i ka wā o ka cardiorespiratory blockade) (Pakaukau 2).
Ma ka hoʻomākaukau ʻana no ka papa PDX, aʻo nā haumāna pre-doctoral i nā protocol diagnostic kūpono (Figure 2) a me ka hoʻomaʻamaʻa kino ma ka PDX manual, physical diagnostics text book, a me nā wikiō wehewehe.ʻO ka nui o ka manawa e pono ai nā haumāna e hoʻomākaukau no ka papa he 60-90 mau minuke.Loaʻa iā ia ka heluhelu ʻana i ka Cluster Packet (12 ʻaoʻao), heluhelu i ka mokuna Bates (~ 20 ʻaoʻao), a me ka nānā ʻana i kahi wikiō (2-6 mau minuke) [19].Na ka hui MS4-SPI e alakaʻi i nā hālāwai ma ke ʻano maʻamau me ka hoʻohana ʻana i ke ʻano i kuhikuhi ʻia ma ka manual (Papa 1).Lawe mua lākou i kahi ho'āʻo waha (maʻa mau 5-7 nīnau) ma ka ʻike mua o ka hālāwai (e laʻa, he aha ka physiology a me ke koʻikoʻi o S3? He aha ka hōʻailona e kākoʻo ana i kona noho ʻana i nā maʻi me ka pōkole o ka hanu?).A laila nānā lākou i nā protocol diagnostic a hoʻomaʻemaʻe i nā kānalua o nā haumāna e komo ana i ke aʻo mua.ʻO ke koena o ka papa he hoʻomaʻamaʻa hope.ʻO ka mea mua, hoʻomākaukau nā haumāna no ka hoʻomaʻamaʻa hoʻomaʻamaʻa kino ma luna o kekahi a ma SPI a hāʻawi i nā manaʻo i ka hui.ʻO ka hope, hāʻawi ʻo SPI iā lākou i kahi haʻawina hihia ma "Small Formative OSCE."Ua hana ʻelua nā haumāna e heluhelu i ka moʻolelo a e hoʻoholo i nā hana hoʻokae i hana ʻia ma ka SPI.A laila, ma muli o nā hopena o ka simulation physics, hoʻopuka nā haumāna pre-graduate i nā kuhiakau a hoʻoholo i ka hōʻailona kūpono loa.Ma hope o ka papa, ua loiloi ka hui SPI-MS4 i kēlā me kēia haumāna a laila hana i kahi loiloi ponoʻī a ʻike i nā wahi e hoʻomaikaʻi ai no ke aʻo ʻana aʻe (Papa 1).He mea nui ka manaʻo o ka papa.Hāʻawi ʻo SPI a me MS4 i nā manaʻo hoʻohālikelike ma ka lele ʻana i kēlā me kēia kau: 1) i ka hana ʻana o nā haumāna i ka hoʻomaʻamaʻa ʻana i kekahi i kekahi a ma SPI 2) i ka wā Mini-OSCE, ua kālele ʻo SPI i ka mechanics a me MS4 i ka noʻonoʻo kino;Hāʻawi pū ʻo SPI a me MS4 i nā manaʻo hōʻuluʻulu i kākau ʻia ma ka hopena o kēlā me kēia kau.Hoʻokomo ʻia kēia manaʻo manaʻo i loko o ka rubric ʻōnaehana hoʻonaʻauao olakino pūnaewele ma ka hopena o kēlā me kēia kau a pili i ka papa hope.
Ua hōʻike nā haumāna e hoʻomākaukau ana no ka hoʻomaʻamaʻa ʻana i ko lākou manaʻo i ka ʻike ma kahi noiʻi i mālama ʻia e ke Keʻena Assessment and Educational Research o George Washington University.He kanaiwakūmāhiku pakeneka o nā haumāna lae pua i ʻae a ʻae paha he waiwai ka papa hana diagnostics kino a ua hoʻokomo ʻia nā manaʻo wehewehe:
“Ke manaʻoʻiʻo nei au ʻo nā papa hana diagnostic kino ka hoʻonaʻauao olakino maikaʻi loa;no ka laʻana, ke aʻo ʻoe mai ka manaʻo o kahi haumāna makahiki ʻehā a hoʻomanawanui, pili a hoʻoikaika ʻia nā haʻawina e nā mea i hana ʻia ma ka papa.
"Hāʻawi ʻo SPI i nā ʻōlelo aʻo maikaʻi loa i nā ala kūpono e hana ai i nā kaʻina hana a hāʻawi i nā ʻōlelo aʻo maikaʻi loa e pili ana i nā nuances e hōʻeha ai i nā maʻi."
"Hana maikaʻi ka SPI a me MS4 a hāʻawi i kahi hiʻohiʻona hou i ke aʻo ʻana i waiwai nui.Hāʻawi ʻo MS4 i ka ʻike i nā pahuhopu o ke aʻo ʻana i ka hana lapaʻau.
“Makemake au e hui pinepine kāua.ʻO kēia kaʻu ʻāpana punahele o ka papa hoʻomaʻamaʻa lapaʻau a manaʻo wau ua pau koke ia. "
Ma waena o nā mea pane, 100% o SPI (N = 16 [100%]) a me MS4 (N = 44 [77%)) i'ōlelo i ko lākouʻike ma keʻano he kumu aʻo PDX he maikaʻi;ʻO 91% a me 93%, kēlā me kēia, o nā SPI a me MS4 i ʻōlelo ua loaʻa iā lākou ka ʻike ma ke ʻano he kumu aʻoaʻo PDX;ʻike maikaʻi o ka hana pū ʻana.
ʻO kā mākou kāʻili maikaʻi ʻana i nā manaʻo o MS4 i kā lākou waiwai i kā lākou ʻike ma ke ʻano he kumu i loaʻa i kēia mau kumuhana: 1) Ka hoʻokō ʻana i ka manaʻo aʻo makua: hoʻoikaika i nā haumāna a me ka hoʻokumu ʻana i kahi kaiapuni aʻo palekana.2) Hoʻomākaukau i ke aʻo ʻana: hoʻolālā ʻana i nā noi lapaʻau kūpono, kakali ʻana i nā nīnau a nā haumāna aʻo, a me ka hui pū ʻana e loaʻa nā pane;3) Hoʻohālike ʻoihana;4) ʻoi aku ka nui o nā manaʻo: hiki wawe a haʻalele lohi;5) Manaʻo manaʻo: e hoʻokahua i ka manawa kūpono, kūpono, hoʻoikaika a hoʻoikaika i nā manaʻo;Hāʻawi i nā mea aʻo i nā ʻōlelo aʻo e pili ana i nā hana aʻo, pehea e hoʻopau ai i nā papa loiloi kino, a me nā ʻōlelo aʻo ʻoihana.
Hoʻokomo nā haumāna Foundation i kahi hōʻike hōʻike OSCE hope ʻekolu ʻāpana ma ka hopena o ke kau kau puna.No ka loiloi i ka pono o kā mākou papahana, ua hoʻohālikelike mākou i ka hana a nā haumāna interns ma ka māhele physics o ka OSCE ma mua a ma hope o ka hoʻomaka ʻana o ka papahana ma 2010. Ma mua o 2010, ua aʻo nā kumu aʻo kauka MS4 i ka PDX i nā haumāna lae pua.Me ka ʻokoʻa o ka makahiki hoʻololi 2010, ua hoʻohālikelike mākou i nā hōʻailona punawai OSCE no ka hoʻonaʻauao kino no 2007–2009 me nā hōʻailona no 2011–2014.ʻO ka nui o nā haumāna e komo ana i ka OSCE mai ka 170 a hiki i ka 185 i kēlā me kēia makahiki: 532 mau haumāna ma ka pūʻulu hana mua a me 714 mau haumāna ma ka hui ma hope o ka hana.
Hōʻuluʻulu ʻia nā helu OSCE mai nā hōʻike punawai 2007–2009 a me 2011–2014, kaupaona ʻia e ka nui o ka laʻana makahiki.E hoʻohana i nā laʻana 2 e hoʻohālikelike i ka GPA kumulative o kēlā me kēia makahiki o ka wā ma mua me ka GPA kumulative o ka wā ma hope me ka hoʻohana ʻana i kahi hoʻokolohua-t.Ua hoʻokuʻu ka GW IRB i kēia haʻawina a loaʻa ka ʻae haumāna e hoʻohana inoa ʻole i kā lākou ʻikepili hoʻonaʻauao no ke aʻo ʻana.
Ua hoʻonui nui ʻia ka helu o ka ʻāpana hoʻokolohua kino mai 83.4 (SD=7.3, n=532) ma mua o ka papahana i 89.9 (SD=8.6, n=714) ma hope o ka papahana (mean change = 6, 5; 95% CI: 5.6 a 7.4; p<0.0001) (Papa 3).Eia nō naʻe, ʻoiai ka hoʻololi ʻana mai ke aʻo ʻana i nā limahana kumu ʻole me nā loli o ka haʻawina, ʻaʻole hiki ke wehewehe maopopo ʻia nā ʻokoʻa o nā helu OSCE e ka hana hou.
ʻO ke kumu hoʻohālike o ka hui SPI-MS4 he ala hou i ke aʻo ʻana i ka ʻike hoʻonaʻauao kino i nā haumāna lapaʻau e hoʻomākaukau iā lākou no ka ʻike mua ʻana.Hāʻawi kēia i kahi koho kūpono ma ke kaʻe ʻana i nā pale e pili ana i ke komo ʻana o ke kumu.Hāʻawi ia i ka waiwai hou i ka hui aʻo a me kā lākou mau haumāna ma mua o ka hoʻomaʻamaʻa: pōmaikaʻi lākou a pau i ke aʻo ʻana.Loaʻa nā pōmaikaʻi i ka hōʻike ʻana i nā haumāna ma mua o ka hoʻomaʻamaʻa ʻana i nā manaʻo like ʻole a me nā kumu hoʻohālike no ka hui pū ʻana [23].ʻO nā hiʻohiʻona ʻē aʻe i loaʻa i ka hoʻonaʻauao like ʻana e hoʻokumu i kahi kaiapuni constructivist [10] kahi e loaʻa ai i kēia mau haumāna ka ʻike mai nā kumu ʻelua: 1) kinesthetic - kūkulu pololei i nā ʻenehana hoʻoikaika kino, 2) synthetic - kūkulu noʻonoʻo diagnostics.E pōmaikaʻi pū ana ʻo MS4 mai ke aʻo like ʻana, e hoʻomākaukau ana iā lākou no ka hana interdisciplinary e hiki mai ana me nā ʻoihana olakino pili.
Loaʻa i kā mākou kumu hoʻohālike nā pono o ke aʻo ʻana o nā hoa [24].Loaʻa nā haumāna ma mua o ka hoʻomaʻamaʻa ʻana i ka cognitive alignment, kahi hoʻonaʻauao palekana, MS4 socialization a me ke ʻano hoʻohālike, a me "ka aʻo pālua" - mai kā lākou aʻo mua ʻana a me nā mea ʻē aʻe;Hōʻike pū lākou i kā lākou hoʻomohala ʻoihana ma ke aʻo ʻana i nā hoa ʻōpio a hoʻohana i nā manawa alakaʻi alakaʻi e hoʻomohala a hoʻomaikaʻi i kā lākou mau aʻo a me nā mākau hoʻokolokolo.Eia hou, hoʻomākaukau kā lākou ʻike aʻo iā lākou e lilo i mau kumu hoʻonaʻauao kūpono ma o ka hoʻomaʻamaʻa ʻana iā lākou e hoʻohana i nā ʻano kumu aʻo kumu hōʻike.
Ua aʻo ʻia nā haʻawina ma ka hoʻokō ʻana i kēia ʻano hoʻohālike.ʻO ka mea mua, he mea nui e ʻike i ka paʻakikī o ka pilina interdisciplinary ma waena o MS4 a me SPI, no ka mea, ʻaʻohe ʻike maopopo o kekahi mau dyads i ka maikaʻi o ka hana pū.ʻO nā hana akaka, nā puke kikoʻī a me nā papa hana hui e hoʻoponopono pono i kēia mau pilikia.ʻO ka lua, pono e hāʻawi ʻia ka hoʻomaʻamaʻa kikoʻī e hoʻomaikaʻi i nā hana o ka hui.ʻOiai e aʻo ʻia nā pūʻulu kumu ʻelua i ke aʻo ʻana, pono hoʻi e aʻo ʻia ʻo SPI i ka hana ʻana i nā mākau hoʻokolohua a MS4 i haku ai.ʻO ke kolu, pono ka hoʻolālā akahele no ka hoʻokō ʻana i ka papa hana paʻa o MS4 a me ka hōʻoia ʻana i ka hui holoʻokoʻa i kēlā me kēia kau loiloi kino.ʻO ka hā, ua manaʻo ʻia nā papahana hou e kūʻē i ke kūʻē ʻana mai nā kumu kula a me ka hoʻokele, me nā hoʻopaʻapaʻa ikaika e pili ana i ka uku-pono;
Ma ka hōʻuluʻulu manaʻo, hōʻike ka SPI-MS4 physical diagnostic aʻoaʻo ʻana i kahi hana hoʻonaʻauao kūʻokoʻa a kūpono hoʻi e hiki ai i nā haumāna lapaʻau ke aʻo maikaʻi i nā mākau kino mai nā mea lapaʻau ʻole.No ka mea kokoke i nā kula lapaʻau a pau ma ʻAmelika Hui Pū ʻIa a me nā kula lapaʻau ʻē aʻe e hoʻohana ana i ka SP, a he nui nā kula lapaʻau i loaʻa nā papahana haumāna-kumu, hiki i kēia kumu hoʻohālike ke hoʻohana ākea.
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