Mwachizoloŵezi, aphunzitsi aphunzitsa kufufuza kwa thupi (PE) kwa obwera kumene kuchipatala (ophunzira), ngakhale kuti pali zovuta ndi zolembera ndi ndalama, komanso zovuta ndi njira zovomerezeka.
Tikupereka chitsanzo chomwe chimagwiritsa ntchito magulu ovomerezeka a alangizi a odwala (SPIs) ndi ophunzira achipatala a chaka chachinayi (MS4s) kuti aphunzitse makalasi a maphunziro a thupi kwa ophunzira oyambirira, kugwiritsa ntchito mwayi wophunzirira mogwirizana komanso mothandizidwa ndi anzawo.
Kafukufuku wa pre-service, MS4 ndi SPI ophunzira adawulula malingaliro abwino a pulogalamuyi, pomwe ophunzira a MS4 adanenanso zakusintha kwakukulu pakudziwika kwawo ngati aphunzitsi.Maphunziro a ophunzira omwe amapita kukayezetsa mayeso a kasupe a luso lachipatala anali ofanana kapena abwino kuposa momwe anzawo amachitira asanakonzekere.
Gulu la SPI-MS4 litha kuphunzitsa bwino ophunzira a novice zamakanika ndi maziko azachipatala a mayeso a novice.
Ophunzira atsopano azachipatala (ophunzira azachipatala) amaphunzira mayeso oyambira (PE) kumayambiriro kwa sukulu ya zamankhwala.Kuchititsa makalasi a maphunziro a thupi kwa ophunzira asukulu yokonzekera.Pachikhalidwe, kugwiritsa ntchito aphunzitsi kulinso ndi zovuta zake, zomwe ndi: 1) ndizokwera mtengo;3) ndizovuta kulemba anthu;4) ndizovuta kuziyika;5) ma nuances angabuke;zolakwa zophonya ndi zoonekeratu [1, 2] 6) Sangakhale odziwa njira zophunzitsira zozikidwa pa umboni [3] 7) Akhoza kuganiza kuti luso la kuphunzitsa maphunziro akuthupi ndi losakwanira [4];
Maphunziro ochita masewera olimbitsa thupi opambana apangidwa pogwiritsa ntchito odwala enieni [5], ophunzira akuluakulu azachipatala kapena okhalamo [6, 7], ndi anthu wamba [8] monga aphunzitsi.Ndikofunika kuzindikira kuti zitsanzo zonsezi ndizofanana kuti zomwe ophunzira amachita m'maphunziro a masewera olimbitsa thupi sachepa chifukwa chosiya kutenga nawo mbali kwa aphunzitsi [5, 7].Komabe, aphunzitsi osaphunzira alibe chidziwitso pazachipatala [9], zomwe ndizofunikira kuti ophunzira athe kugwiritsa ntchito deta yamasewera kuti ayese malingaliro ozindikira.Pofuna kuthana ndi kufunikira kokhazikika komanso zochitika zachipatala pakuphunzitsa zolimbitsa thupi, gulu la aphunzitsi linawonjezera machitidwe owonetsetsa omwe amayendetsedwa ndi malingaliro pazophunzitsa zawo zapagulu [10].Ku George Washington University (GWU) School of Medicine, tikuthana ndi vuto limeneli kudzera mu chitsanzo cha magulu okhazikika a ophunzitsa odwala (SPIs) ndi ophunzira akuluakulu azachipatala (MS4s).(Chithunzi 1) SPI imaphatikizidwa ndi MS4 kuti iphunzitse PE kwa ophunzira.SPI imapereka ukadaulo wamakaniko a mayeso a MS4 pazachipatala.Chitsanzochi chimagwiritsa ntchito maphunziro ogwirizana, chomwe ndi chida champhamvu chophunzirira [11].Chifukwa SP imagwiritsidwa ntchito pafupifupi m'masukulu onse azachipatala aku US ndi masukulu ambiri apadziko lonse lapansi [12, 13], ndipo masukulu ambiri azachipatala ali ndi mapulogalamu aukadaulo wa ophunzira, chitsanzochi chikhoza kugwiritsidwa ntchito mokulirapo.Cholinga cha nkhaniyi ndikufotokozera mtundu wapadera wa masewera a SPI-MS4 (Chithunzi 1).
Kufotokozera mwachidule za mtundu wa maphunziro ogwirizana a MS4-SPI.MS4: Chaka Chachinayi Wophunzira Zachipatala SPI: Mlangizi Wokhazikika Wodwala;
Kuzindikira kwakuthupi kofunikira (PDX) ku GWU ndi gawo limodzi la maphunziro aukadaulo azachipatala asanakhale clerkship.Zigawo zina: 1) Kuphatikizana kwachipatala (magulu amagulu potengera mfundo ya PBL);2) Mafunso;3) Zochita zolimbitsa thupi OSCE;4) Maphunziro a zachipatala (kugwiritsa ntchito luso lachipatala pogwiritsa ntchito madokotala);5) Kuphunzitsa kwa chitukuko cha akatswiri;PDX imagwira ntchito m'magulu a ophunzira 4-5 omwe amagwira ntchito pagulu lomwelo la SPI-MS4, amakumana kasanu ndi kamodzi pachaka kwa maola atatu aliyense.Kukula kwa kalasi kuli pafupifupi ophunzira 180, ndipo chaka chilichonse ophunzira pakati pa 60 ndi 90 MS4 amasankhidwa kukhala aphunzitsi a maphunziro a PDX.
MS4s amalandira maphunziro a aphunzitsi kudzera mu TALKS (Chidziwitso Chophunzitsa ndi Maluso) apamwamba osankhidwa ndi aphunzitsi, omwe amaphatikizapo zokambirana za mfundo zamaphunziro achikulire, luso la kuphunzitsa, ndi kupereka ndemanga [14].Ma SPI amaphunzitsidwa mozama zautali wopangidwa ndi CLASS Simulation Center Assistant Director (JO).Maphunziro a SP amapangidwa motsatira malangizo opangidwa ndi aphunzitsi omwe amaphatikiza mfundo zamaphunziro a akulu, masitayilo ophunzirira, ndi utsogoleri wamagulu ndi zolimbikitsa.Makamaka, maphunziro a SPI ndi kuyimitsidwa kumachitika m'magawo angapo, kuyambira nthawi yachilimwe ndikupitilira chaka chonse chasukulu.Maphunziro akuphatikizapo momwe angaphunzitsire, kulankhulana ndi kuchititsa makalasi;momwe phunzirolo likugwirizanirana ndi maphunziro onse;momwe angaperekere ndemanga;momwe angachitire masewera olimbitsa thupi ndikuwaphunzitsa kwa ophunzira.Kuti awone luso la pulogalamuyi, ma SPI ayenera kuchita mayeso oyika omwe amayendetsedwa ndi membala waofesi ya SP.
MS4 ndi SPI nawonso adatenga nawo gawo pamisonkhano yamagulu ya maola awiri yofotokozera ntchito zawo zowonjezera pokonzekera ndi kukhazikitsa maphunziro ndi kuyesa ophunzira omwe akulowa maphunziro asanayambe ntchito.Mapangidwe a msonkhanowo anali chitsanzo cha GRPI (zolinga, maudindo, ndondomeko ndi zochitika za anthu) ndi chiphunzitso cha Mezirow cha maphunziro osinthika (ndondomeko, malo ndi zomwe zili) pophunzitsa mfundo zophunzirira zamagulu osiyanasiyana (zowonjezera) [15, 16].Kugwira ntchito limodzi ngati aphunzitsi ogwirizana kumagwirizana ndi malingaliro ophunzirira anthu komanso odziwa zambiri: kuphunzira kumapangidwa mukusinthana kwamagulu pakati pa mamembala amagulu [17].
Maphunziro a PDX amapangidwa mozungulira mtundu wa Core and Clusters (C+C) [18] pophunzitsa PE malinga ndi malingaliro azachipatala kwa miyezi 18, ndipo maphunziro a gulu lililonse amayang'ana pazowonetsa odwala.Ophunzira adzaphunzira gawo loyamba la C+C, mayeso agalimoto a mafunso 40 omwe amakhudza machitidwe akuluakulu a ziwalo.Mayeso oyambira ndi mayeso osavuta komanso othandiza omwe alibe msonkho wocheperako poyerekeza ndi mayeso achikhalidwe.Mayeso apakati ndi abwino pokonzekeretsa ophunzira kuti adziwe zachipatala ndipo amavomerezedwa ndi masukulu ambiri.Ophunzira kenako amapita ku gawo lachiwiri la C+C, Diagnostic Cluster, lomwe ndi gulu la H&Ps loyendetsedwa ndi malingaliro opangidwa mozungulira mawonetsedwe apadera azachipatala opangidwa kuti akulitse luso la kulingalira.Kupweteka pachifuwa ndi chitsanzo cha mawonetseredwe achipatala oterewa (Table 1).Magulu amachotsa zochitika zoyambira pakuyezetsa koyambirira (mwachitsanzo, kukulitsa mtima kwamtima) ndikuwonjezera zina, zapadera zomwe zimathandiza kusiyanitsa luso lozindikira matenda (mwachitsanzo, kumvetsera mawu owonjezera amtima pamalo a lateral decubitus).C+C imaphunzitsidwa m'miyezi 18 ndipo maphunziro amapitilira, ophunzira amayamba kuphunzitsidwa pafupifupi mayeso oyambira 40, kenako, akakonzeka, amasamukira m'magulu, aliyense akuwonetsa machitidwe azachipatala omwe akuyimira gawo la organ system.wophunzira amakumana (mwachitsanzo, kupweteka pachifuwa ndi kupuma movutikira panthawi ya kutsekeka kwa mtima) (Table 2).
Pokonzekera maphunziro a PDX, ophunzira a pre-doctoral amaphunzira njira zoyenera zodziwira matenda (Chithunzi 2) ndi maphunziro a thupi m'buku la PDX, bukhu la matenda a thupi, ndi mavidiyo ofotokozera.Nthawi yonse yofunikira kuti ophunzira akonzekere maphunzirowa ndi pafupifupi mphindi 60-90.Zimaphatikizapo kuwerenga Cluster Packet (masamba 12), kuwerenga mutu wa Bates (~ masamba 20), ndikuwonera kanema (2-6 minutes) [19].Gulu la MS4-SPI limachita misonkhano mokhazikika pogwiritsa ntchito njira yomwe yafotokozedwa mu bukhuli (Table 1).Poyamba amayesa mayeso a pakamwa (kawirikawiri mafunso 5-7) pa chidziwitso chisanachitike (mwachitsanzo, physiology ndi tanthauzo la S3 ndi chiyani? Ndi matenda otani omwe amathandiza kukhalapo kwake kwa odwala omwe ali ndi mpweya wochepa?).Kenako amawunikanso njira zowunikira ndikuchotsa kukayikira kwa ophunzira omwe akulowa maphunziro asukulu yoyamba.Chotsalira cha maphunzirowa ndi masewera omaliza.Choyamba, ophunzira akukonzekera kuchita masewera olimbitsa thupi wina ndi mzake komanso pa SPI ndikupereka ndemanga kwa gulu.Pomaliza, a SPI adawapatsa phunziro la "Small Formative OSCE."Ophunzira ankagwira ntchito awiriawiri kuti awerenge nkhaniyo ndi kupanga malingaliro okhudza tsankho zomwe zimachitika pa SPI.Kenako, kutengera zotsatira za kayeseleledwe ka fiziki, ophunzira omwe amaliza maphunziro awo amaika malingaliro awo ndikulingalira zomwe zingachitike.Pambuyo pa maphunzirowa, gulu la SPI-MS4 linayesa wophunzira aliyense ndikudziyesa yekha ndikuzindikira madera omwe angafunikire kukonza maphunziro otsatirawa (Table 1).Ndemanga ndichinthu chofunikira kwambiri pamaphunzirowa.SPI ndi MS4 zimapereka ndemanga zowonetsera pa-n-fly pa gawo lililonse: 1) pamene ophunzira akuchitirana zolimbitsa thupi wina ndi mnzake komanso pa SPI 2) pa Mini-OSCE, SPI imayang'ana zamakanika ndipo MS4 imayang'ana pamalingaliro azachipatala;SPI ndi MS4 imaperekanso ndemanga zolembedwa mwachidule kumapeto kwa semesita iliyonse.Ndemanga zovomerezekazi zimalowetsedwa mu rubriki yoyang'anira maphunziro azachipatala pa intaneti kumapeto kwa semesita iliyonse ndipo zimakhudza giredi yomaliza.
Ophunzira omwe akukonzekera ma internship adagawana malingaliro awo pazomwe adakumana nazo mu kafukufuku wopangidwa ndi dipatimenti yowunika ndi kafukufuku wamaphunziro a yunivesite ya George Washington.Makumi asanu ndi anayi mphambu asanu ndi awiri pa zana aliwonse a ophunzira omwe sanamalize maphunziro apamwamba adavomera kapena kuvomereza kuti maphunziro owunikira thupi anali ofunika ndipo adaphatikizanso ndemanga zofotokozera:
“Ndimakhulupirira kuti maphunziro oyezera matenda akuthupi ndiwo maphunziro abwino kwambiri a zachipatala;mwachitsanzo, mukamaphunzitsa kuchokera kwa wophunzira wazaka zinayi ndi wodwala, zipangizozo zimakhala zofunikira komanso zimalimbikitsidwa ndi zomwe zikuchitika m'kalasi.
"SPI imapereka upangiri wabwino kwambiri panjira zogwirira ntchito ndipo imapereka upangiri wabwino kwambiri pazomwe zingayambitse odwala."
"SPI ndi MS4 zimagwirira ntchito limodzi bwino ndikupereka malingaliro atsopano ophunzitsira omwe ndi ofunika kwambiri.MS4 imapereka chidziwitso pazolinga zophunzitsira muzochita zachipatala.
“Ndikufuna kuti tizikumana pafupipafupi.Iyi ndi gawo lomwe ndimakonda kwambiri pamaphunziro azachipatala ndipo ndikuwona ngati amatha mwachangu. ”
Pakati pa omwe adafunsidwa, 100% ya SPI (N=16 [100%]) ndi MS4 (N=44 [77%]) adanena kuti zomwe adakumana nazo monga mphunzitsi wa PDX zinali zabwino;91% ndi 93%, motero, a SPIs ndi MS4s adanena kuti anali ndi chidziwitso monga mphunzitsi wa PDX;chidziwitso chabwino chogwirira ntchito limodzi.
Kusanthula kwathu kwabwino kwa momwe MS4's amawonera zomwe adaziwona kukhala zamtengo wapatali pazomwe adakumana nazo monga aphunzitsi zidabweretsa mitu iyi: 1) Kukhazikitsa chiphunzitso cha maphunziro a akulu: kulimbikitsa ophunzira ndikukhazikitsa malo ophunzirira otetezeka.2) Kukonzekera kuphunzitsa: kukonzekera ntchito yoyenera yachipatala, kuyembekezera mafunso ophunzitsidwa, ndi kugwirizana kuti tipeze mayankho;3) Kutengera luso laukadaulo;4) Kupyola zoyembekeza: kufika mofulumira ndi kuchoka mochedwa;5) Ndemanga: kuyika patsogolo pa nthawi yake, zomveka, zolimbikitsa komanso zolimbikitsa;Apatseni malangizo okhudza momwe mungaphunzirire, momwe mungamalizire bwino maphunziro oyesa thupi, ndi upangiri wantchito.
Ophunzira a Foundation amatenga nawo mbali pamayeso atatu omaliza a OSCE kumapeto kwa semester ya masika.Kuti tiwone momwe pulogalamu yathu ikuyendera, tidafanizira momwe ophunzira amachitira mu gawo la physics la OSCE isanayambike komanso itatha kukhazikitsidwa kwa 2010. Chaka cha 2010 chisanafike, aphunzitsi a udokotala a MS4 adaphunzitsa PDX kwa ophunzira omwe adamaliza maphunziro awo.Kupatulapo chaka cha kusintha cha 2010, tidafanizira zizindikiro za OSCE zamaphunziro amthupi za 2007-2009 ndi zizindikiro za 2011-2014.Chiwerengero cha ophunzira omwe adatenga nawo gawo mu OSCE adachokera ku 170 mpaka 185 pachaka: ophunzira 532 omwe ali mgulu lothandizira komanso ophunzira 714 omwe ali mgulu la post-intervention.
Zotsatira za OSCE za 2007-2009 ndi 2011-2014 mayeso a masika amawerengedwa mwachidule, molemera ndi kukula kwa zitsanzo zapachaka.Gwiritsani ntchito zitsanzo ziwiri kuyerekeza kuchuluka kwa GPA ya chaka chilichonse cha nthawi yapitayi ndi GPA yowonjezereka ya nthawi yamtsogolo pogwiritsa ntchito mayeso a t.A GW IRB sanakhululukire kafukufukuyu ndipo adalandira chilolezo cha ophunzira kuti agwiritse ntchito mosadziwika deta yawo yamaphunziro pa kafukufukuyu.
Chiwongola dzanja chapakati chowunika chinawonjezeka kwambiri kuchokera ku 83.4 (SD = 7.3, n = 532) pulogalamu isanakwane mpaka 89.9 (SD = 8.6, n = 714) pambuyo pa pulogalamu (kutanthauza kusintha = 6, 5; 95% CI: 5.6 mpaka 7.4; p<0.0001) (Table 3).Komabe, popeza kusintha kochokera kwa ophunzitsa kupita kwa osaphunzitsa kumagwirizana ndi kusintha kwa maphunziro, kusiyana kwamaphunziro a OSCE sikungafotokozedwe momveka bwino ndi luso.
Njira yophunzitsira ya gulu la SPI-MS4 ndi njira yatsopano yophunzitsira chidziwitso cha maphunziro akuthupi kwa ophunzira azachipatala kuti awakonzekeretse kuti adziwike msanga.Izi zimapereka njira ina yothandiza popewa zopinga zomwe zimagwirizanitsidwa ndi kutenga nawo mbali kwa aphunzitsi.Zimaperekanso phindu lowonjezera kwa gulu lophunzitsa ndi ophunzira awo omwe adachita kale: onse amapindula pophunzira pamodzi.Ubwino umaphatikizapo kuwonetsa ophunzira asanayambe kuchita nawo malingaliro osiyanasiyana ndi zitsanzo za mgwirizano [23].Malingaliro ena omwe amapezeka mu maphunziro ogwirizana amapanga malo olimbikitsa [10] momwe ophunzirawa amapeza chidziwitso kuchokera kuzinthu ziwiri: 1) kinesthetic - kumanga njira zolimbitsa thupi zenizeni, 2) kupanga - kumanga malingaliro ozindikira.Ma MS4 amapindulanso ndi maphunziro ogwirizana, kuwakonzekeretsa ntchito zamtsogolo zamagulu osiyanasiyana ndi akatswiri ogwirizana nawo azaumoyo.
Chitsanzo chathu chimaphatikizaponso ubwino wophunzirira anzawo [24].Ophunzira asanayambe maphunziro amapindula ndi kugwirizanitsa chidziwitso, malo ophunzirira otetezeka, MS4 socialization ndi role modeling, ndi "kuphunzira pawiri" -kuchokera ku maphunziro awo oyambirira ndi ena;Amasonyezanso chitukuko chawo mwa kuphunzitsa anzawo achichepere ndikugwiritsa ntchito mwayi wotsogozedwa ndi aphunzitsi kukulitsa ndi kupititsa patsogolo luso lawo la kuphunzitsa ndi kulemba.Komanso, zokumana nazo zawo pophunzitsa zimawakonzekeretsa kukhala aphunzitsi ogwira mtima mwa kuwaphunzitsa kugwiritsa ntchito njira zophunzitsira zozikidwa pa umboni.
Maphunziro adaphunziridwa pakukhazikitsa chitsanzo ichi.Choyamba, ndikofunikira kuzindikira zovuta za ubale wapakati pa MS4 ndi SPI, popeza ma dyad ena samamvetsetsa bwino momwe angagwirire ntchito limodzi.Maudindo omveka bwino, zolemba zatsatanetsatane ndi zokambirana zamagulu zimathetsa izi.Chachiwiri, maphunziro atsatanetsatane ayenera kuperekedwa kuti akwaniritse bwino ntchito zamagulu.Ngakhale magulu onse awiri a aphunzitsi ayenera kuphunzitsidwa kuphunzitsa, SPI ikufunikanso kuphunzitsidwa momwe angachitire maluso a mayeso omwe MS4 adawadziwa kale.Chachitatu, kukonzekera mosamala kumafunika kuti mugwirizane ndi nthawi yotanganidwa ya MS4 ndikuwonetsetsa kuti gulu lonse likupezeka pa gawo lililonse lowunika.Chachinayi, mapulogalamu atsopano akuyembekezeka kuyang'anizana ndi kukana kuchokera kwa aphunzitsi ndi oyang'anira, ndi zifukwa zomveka zokomera mtengo;
Mwachidule, chitsanzo cha SPI-MS4 chophunzitsira chodziwira matenda chikuyimira luso lapadera komanso lothandiza la maphunziro omwe ophunzira azachipatala angaphunzire bwino luso lakuthupi kuchokera kwa omwe sali madokotala ophunzitsidwa bwino.Popeza pafupifupi masukulu onse azachipatala ku United States ndi masukulu ambiri azachipatala akunja amagwiritsa ntchito SP, ndipo masukulu ambiri azachipatala ali ndi mapulogalamu ophunzitsa ophunzira, chitsanzochi chikhoza kugwiritsidwa ntchito mokulirapo.
Deta ya kafukufukuyu ikupezeka kuchokera kwa Dr. Benjamin Blatt, MD, Mtsogoleri wa GWU Study Center.Deta yathu yonse ikuwonetsedwa mu phunziroli.
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Nthawi yotumiza: May-11-2024