Mwachikhalidwe, aphunzitsi akhala amaphunzitsa mayeso olimbitsa thupi (PE) kwa oyamba kumene azachipatala (ophunzira), ngakhale kuti panali mavuto okhudzana ndi kulemba anthu ntchito komanso ndalama zomwe amawononga, komanso mavuto okhudzana ndi njira zodziwika bwino.
Tikupereka chitsanzo chomwe chimagwiritsa ntchito magulu okhazikika a aphunzitsi odwala (SPIs) ndi ophunzira azachipatala a chaka chachinayi (MS4s) pophunzitsa makalasi ophunzitsira thupi kwa ophunzira asanaphunzire zachipatala, pogwiritsa ntchito bwino kuphunzira kogwirizana komanso kothandizidwa ndi anzawo.
Kafukufuku wa ophunzira asanayambe maphunziro, MS4 ndi SPI wasonyeza malingaliro abwino pa pulogalamuyi, ndipo ophunzira a MS4 adanenanso kuti asintha kwambiri pa ntchito yawo monga aphunzitsi. Kuchita bwino kwa ophunzira asanayambe maphunziro pa mayeso aukadaulo a masika kunali kofanana kapena kuposa kuchita bwino kwa anzawo asanayambe maphunziro.
Gulu la SPI-MS4 lingathe kuphunzitsa bwino ophunzira atsopano njira zowunikira thupi la oyamba kumene komanso maziko azachipatala.
Ophunzira atsopano azachipatala (ophunzira asanapite ku udokotala) amaphunzira mayeso oyambira a thupi (PE) kumayambiriro kwa sukulu ya zamankhwala. Chitani makalasi a maphunziro olimbitsa thupi kwa ophunzira a kusukulu yokonzekera. Mwachikhalidwe, kugwiritsa ntchito aphunzitsi kulinso ndi zovuta, zomwe ndi: 1) ndi okwera mtengo; 3) ndi ovuta kuwalemba ntchito; 4) ndi ovuta kuwakhazikitsa; 5) mfundo zina zingabuke; zolakwika zomwe zaphonya komanso zoonekeratu [1, 2] 6) Mwina sangadziwe njira zophunzitsira zochokera ku umboni [3] 7) Angaganize kuti luso lophunzitsa maphunziro olimbitsa thupi silikwanira [4];
Zitsanzo zophunzitsira zolimbitsa thupi zopambana zapangidwa pogwiritsa ntchito odwala enieni [5], ophunzira azachipatala okalamba kapena okhalamo [6, 7], ndi anthu wamba [8] ngati aphunzitsi. Ndikofunika kudziwa kuti zitsanzo zonsezi ndizofanana kuti magwiridwe antchito a ophunzira m'maphunziro olimbitsa thupi sachepa chifukwa chopatula kutenga nawo mbali kwa aphunzitsi [5, 7]. Komabe, aphunzitsi wamba alibe chidziwitso pazochitika zachipatala [9], zomwe ndizofunikira kuti ophunzira athe kugwiritsa ntchito deta yamasewera poyesa malingaliro ozindikira. Pofuna kuthana ndi kufunikira kwa miyezo ndi zochitika zachipatala pophunzitsa maphunziro olimbitsa thupi, gulu la aphunzitsi linawonjezera machitidwe ozindikira omwe amayendetsedwa ndi malingaliro pamaphunziro awo wamba [10]. Ku George Washington University (GWU) School of Medicine, tikukwaniritsa izi kudzera mu chitsanzo cha magulu okhazikika a aphunzitsi odwala (SPIs) ndi ophunzira azachipatala okalamba (MS4s). (Chithunzi 1) SPI imagwirizanitsidwa ndi MS4 kuti iphunzitse ophunzira PE. SPI imapereka ukatswiri pamakina oyesera MS4 muzochitika zachipatala. Chitsanzochi chimagwiritsa ntchito kuphunzira kogwirizana, komwe ndi chida champhamvu chophunzirira [11]. Popeza SP imagwiritsidwa ntchito pafupifupi m'masukulu onse azachipatala aku US komanso m'masukulu ambiri apadziko lonse lapansi [12, 13], ndipo masukulu ambiri azachipatala ali ndi mapulogalamu ophunzitsira ophunzira, chitsanzochi chili ndi kuthekera kogwiritsidwa ntchito kwambiri. Cholinga cha nkhaniyi ndikufotokozera chitsanzo chapadera ichi cha SPI-MS4 chophunzitsira masewera a timu (Chithunzi 1).
Kufotokozera mwachidule za njira yophunzirira yogwirizana ya MS4-SPI. MS4: SPI ya Wophunzira Zachipatala wa Chaka Chachinayi: Mphunzitsi Wodwala Wokhazikika;
Kuzindikira matenda ofunikira (PDX) ku GWU ndi gawo limodzi la maphunziro aukadaulo a zamankhwala asanayambe ntchito ya udokotala. Zina mwa izi: 1) Kuphatikizana kwachipatala (magawo amagulu kutengera mfundo ya PBL); 2) Kuyankhulana; 3) Zochita zophunzitsira OSCE; 4) Maphunziro azachipatala (kugwiritsa ntchito luso lachipatala ndi madokotala ochita ntchito); 5) Kuphunzitsa chitukuko chaukadaulo; PDX imagwira ntchito m'magulu a ophunzira 4-5 omwe amagwira ntchito mu gulu lomwelo la SPI-MS4, amakumana kasanu ndi kamodzi pachaka kwa maola atatu aliyense. Chiwerengero cha ophunzira ndi pafupifupi 180, ndipo chaka chilichonse ophunzira pakati pa 60 ndi 90 a MS4 amasankhidwa kukhala aphunzitsi a maphunziro a PDX.
Ophunzira a MS4 amalandira maphunziro a aphunzitsi kudzera mu maphunziro athu apamwamba a TALKS (Teaching Knowledge and Skills), omwe amaphatikizapo misonkhano yokhudza mfundo zophunzirira akuluakulu, luso lophunzitsa, ndi kupereka ndemanga [14]. Ma SPI amaphunzira pulogalamu yophunzitsira ya nthawi yayitali yopangidwa ndi Wothandizira Wothandizira wa CLASS Simulation Center (JO). Maphunziro a SP amapangidwa motsatira malangizo opangidwa ndi aphunzitsi omwe amaphatikizapo mfundo zophunzirira akuluakulu, njira zophunzirira, ndi utsogoleri wamagulu ndi chilimbikitso. Makamaka, maphunziro a SPI ndi kukhazikika kumachitika m'magawo angapo, kuyambira chilimwe ndikupitilira chaka chonse cha sukulu. Maphunziro akuphatikizapo momwe mungaphunzitsire, kulankhulana, ndi kutsogolera makalasi; momwe phunzirolo limagwirizanirana ndi maphunziro ena onse; momwe mungaperekere ndemanga; momwe mungachitire masewera olimbitsa thupi ndikuphunzitsa ophunzira. Kuti muwone luso la pulogalamuyi, ma SPI ayenera kupambana mayeso oyikidwa omwe amaperekedwa ndi membala wa aphunzitsi a SP.
MS4 ndi SPI adatenga nawo gawo pa msonkhano wa gulu wa maola awiri pamodzi kuti afotokoze maudindo awo ogwirizana pakukonzekera ndi kukhazikitsa maphunziro ndikuwunika ophunzira omwe akuyamba maphunziro asanalowe usilikali. Kapangidwe ka msonkhanowu kanali chitsanzo cha GRPI (zolinga, maudindo, njira ndi zinthu zokhudzana ndi anthu) ndi chiphunzitso cha Mezirow cha kuphunzira kosinthika (njira, malo ndi zomwe zili mkati) pophunzitsa mfundo zophunzirira zosiyanasiyana (zowonjezera) [15, 16]. Kugwira ntchito limodzi ngati aphunzitsi othandizana kumagwirizana ndi mfundo zophunzirira za chikhalidwe cha anthu ndi zochitika: kuphunzira kumapangidwa posinthana pakati pa mamembala a gulu [17].
Maphunziro a PDX amapangidwa motsatira chitsanzo cha Core ndi Clusters (C+C) [18] chophunzitsira PE poganizira zachipatala kwa miyezi 18, ndipo maphunziro a gulu lililonse amayang'ana kwambiri pa mafotokozedwe a odwala. Ophunzira poyamba amaphunzira gawo loyamba la C+C, mayeso a minofu a mafunso 40 okhudza ziwalo zazikulu. Mayeso oyambira ndi mayeso osavuta komanso othandiza omwe savuta kwambiri kuposa mayeso wamba wamba. Mayeso apakati ndi abwino pokonzekera ophunzira kuti azitha kuchita bwino kuchipatala ndipo amavomerezedwa ndi masukulu ambiri. Kenako ophunzira amapitilira ku gawo lachiwiri la C+C, Diagnostic Cluster, lomwe ndi gulu la H&Ps loyendetsedwa ndi malingaliro lomwe limakonzedwa motsatira mafotokozedwe apadera azachipatala omwe adapangidwa kuti apange luso loganiza zachipatala. Kupweteka pachifuwa ndi chitsanzo cha kuwonetseredwa kwachipatala kotere (Table 1). Magulu amatenga zochitika zazikulu kuchokera ku mayeso oyamba (monga, kumvetsera mawu owonjezera amtima) ndikuwonjezera zochitika zina zapadera zomwe zimathandiza kusiyanitsa kuthekera kozindikira (monga, kumvetsera mawu owonjezera amtima pamalo ozungulira a decubitus). C+C imaphunzitsidwa kwa miyezi 18 ndipo maphunziro ake amakhala opitilira, pomwe ophunzira amaphunzitsidwa koyamba mayeso pafupifupi 40 apakati a minofu kenako, akakonzeka, amasamutsidwa m'magulu, aliyense akuwonetsa momwe thupi limagwirira ntchito poyimira gawo la ziwalo. Ophunzira amakumana ndi izi (monga kupweteka pachifuwa ndi kupuma movutikira panthawi yotseka mtima ndi kupuma) (Table 2).
Pokonzekera maphunziro a PDX, ophunzira asanapite ku udokotala amaphunzira njira zoyenera zodziwira matenda (Chithunzi 2) ndi maphunziro olimbitsa thupi m'buku la PDX, buku lophunzitsira matenda olimbitsa thupi, ndi makanema ofotokozera. Nthawi yonse yomwe ophunzira amafunika kukonzekera maphunzirowa ndi pafupifupi mphindi 60-90. Izi zikuphatikizapo kuwerenga Cluster Packet (masamba 12), kuwerenga chaputala cha Bates (masamba ~ 20), ndikuonera kanema (mphindi 2-6) [19]. Gulu la MS4-SPI limachita misonkhano motsatira njira yomwe yafotokozedwa m'bukuli (Table 1). Choyamba amayesa mayeso a pakamwa (nthawi zambiri mafunso 5-7) pa chidziwitso cha pre-session (monga, kodi physiology ndi kufunika kwa S3 ndi chiyani? Ndi matenda ati omwe amathandizira kupezeka kwake mwa odwala omwe ali ndi vuto lopuma movutikira?). Kenako amawunikanso njira zodziwira matenda ndikuchotsa kukayikira kwa ophunzira omwe akuyamba maphunziro a pre-graduate. Gawo lotsala la maphunzirowa ndi masewera olimbitsa thupi omaliza. Choyamba, ophunzira omwe akukonzekera kuchita masewera olimbitsa thupi amachita masewera olimbitsa thupi pa wina ndi mnzake komanso pa SPI ndikupereka ndemanga kwa gululo. Pomaliza, SPI inawapatsa phunziro la "Small Formative OSCE." Ophunzira anagwira ntchito awiriawiri kuti awerenge nkhaniyi ndikupanga malingaliro okhudza zochita zosiyanasiyana zomwe zinachitika pa SPI. Kenako, kutengera zotsatira za kuyeserera kwa fizikisi, ophunzira asanamalize maphunziro awo adapereka malingaliro ndikupereka matenda omwe angakhalepo. Pambuyo pa maphunzirowa, gulu la SPI-MS4 linayesa wophunzira aliyense kenako linadziyesa lokha ndikupeza madera oti apite patsogolo pa maphunziro otsatira (Table 1). Ndemanga ndi gawo lofunika kwambiri pa maphunzirowa. SPI ndi MS4 zimapereka mayankho ofunikira nthawi zonse pa gawo lililonse: 1) pamene ophunzira akuchita masewera olimbitsa thupi pa wina ndi mnzake komanso pa SPI 2) panthawi ya Mini-OSCE, SPI imayang'ana kwambiri pa makina ndipo MS4 imayang'ana kwambiri pa kulingalira kwachipatala; SPI ndi MS4 imaperekanso ndemanga yolembedwa mwachidule kumapeto kwa semesita iliyonse. Ndemanga yovomerezekayi imalowetsedwa mu rubric ya njira yoyendetsera maphunziro azachipatala pa intaneti kumapeto kwa semesita iliyonse ndipo imakhudza giredi yomaliza.
Ophunzira omwe akukonzekera maphunziro a internship adagawana malingaliro awo pa zomwe adakumana nazo mu kafukufuku wochitidwa ndi George Washington University Department of Assessment and Educational Research. 97% ya ophunzira a undergraduate adavomereza mwamphamvu kapena adavomereza kuti maphunziro ofufuza matenda a thupi anali ofunika ndipo adaphatikizapo ndemanga zofotokozera:
"Ndimakhulupirira kuti maphunziro ofufuza matenda a thupi ndi maphunziro abwino kwambiri azachipatala; mwachitsanzo, mukamaphunzitsa kuchokera kwa wophunzira wa chaka chachinayi ndi wodwala, zipangizozo zimakhala zogwirizana ndi zomwe zikuchitika mkalasi."
"SPI imapereka upangiri wabwino kwambiri pa njira zothandiza zochitira opaleshoni ndipo imapereka upangiri wabwino kwambiri pa zinthu zina zomwe zingayambitse kusasangalala kwa odwala."
"SPI ndi MS4 zimagwira ntchito bwino limodzi ndipo zimapereka lingaliro latsopano pa kuphunzitsa lomwe ndi lofunika kwambiri. MS4 imapereka chidziwitso pa zolinga za kuphunzitsa m'machitidwe azachipatala."
"Ndikufuna kuti tizikumana pafupipafupi. Iyi ndi gawo lomwe ndimakonda kwambiri pa maphunziro azachipatala ndipo ndikuona kuti limatha msanga kwambiri."
Pakati pa omwe adafunsidwa, 100% ya SPI (N=16 [100%]) ndi MS4 (N=44 [77%]) adati zomwe adakumana nazo monga mphunzitsi wa PDX zinali zabwino; 91% ndi 93%, motsatana, a SPI ndi MS4 adati adakumana nazo monga mphunzitsi wa PDX; zomwe adakumana nazo zabwino zogwirira ntchito limodzi.
Kusanthula kwathu kwa malingaliro a MS4 pa zomwe adaziona monga aphunzitsi kunabweretsa mitu iyi: 1) Kugwiritsa ntchito chiphunzitso cha kuphunzira kwa akuluakulu: kulimbikitsa ophunzira ndikupanga malo otetezeka ophunzirira. 2) Kukonzekera kuphunzitsa: kukonzekera kugwiritsa ntchito koyenera kuchipatala, kuyembekezera mafunso a ophunzira, ndikugwirizana kuti mupeze mayankho; 3) Kuwonetsa ukatswiri; 4) Kupitirira zomwe amayembekezera: kufika msanga ndikuchoka mochedwa; 5) Ndemanga: Kuyika patsogolo ndemanga za panthawi yake, zomveka, zolimbikitsa komanso zomanga; Kupatsa ophunzira upangiri pa zizolowezi zophunzirira, momwe angamalizire maphunziro owunikira thupi, ndi upangiri wa ntchito.
Ophunzira a Foundation amatenga nawo mbali pa mayeso omaliza a OSCE a magawo atatu kumapeto kwa semesita ya masika. Kuti tiwone momwe pulogalamu yathu ikuyendera bwino, tinayerekeza momwe ophunzira amagwirira ntchito mu gawo la fizikisi la OSCE isanayambe komanso itatha kukhazikitsidwa kwa pulogalamuyi mu 2010. Asanafike chaka cha 2010, aphunzitsi azachipatala a MS4 ankaphunzitsa PDX kwa ophunzira a digiri yoyamba. Kupatula chaka cha kusintha kwa 2010, tinayerekeza zizindikiro za masika za OSCE za maphunziro olimbitsa thupi a 2007-2009 ndi zizindikiro za 2011-2014. Chiwerengero cha ophunzira omwe adatenga nawo mbali mu OSCE chinali kuyambira 170 mpaka 185 pachaka: ophunzira 532 m'gulu loyambirira ndi ophunzira 714 m'gulu loyambirira.
Zigoli za OSCE kuchokera ku mayeso a masika a 2007-2009 ndi 2011-2014 zafupikitsidwa, kuyesedwa ndi kukula kwa zitsanzo zapachaka. Gwiritsani ntchito zitsanzo ziwiri kuyerekeza GPA yokwanira ya chaka chilichonse cha nthawi yapitayi ndi GPA yokwanira ya nthawi yotsatira pogwiritsa ntchito mayeso a t. GW IRB sinavomereze kafukufukuyu ndipo inapeza chilolezo cha ophunzira kuti agwiritse ntchito deta yawo yamaphunziro mosadziwika pa kafukufukuyu.
Chiwerengero chapakati cha mayeso a thupi chinakwera kwambiri kuchokera pa 83.4 (SD=7.3, n=532) pulogalamu isanayambe kufika pa 89.9 (SD=8.6, n=714) pulogalamu itatha (kusintha kwapakati = 6, 5; 95% CI: 5.6 mpaka 7.4; p<0.0001) (Table 3). Komabe, popeza kusintha kuchoka pa kuphunzitsa kupita ku ntchito yosaphunzitsa kumagwirizana ndi kusintha kwa maphunziro, kusiyana kwa zigoli za OSCE sikungathe kufotokozedwa momveka bwino ndi luso latsopano.
Chitsanzo chophunzitsira cha gulu la SPI-MS4 ndi njira yatsopano yophunzitsira chidziwitso choyambira cha maphunziro olimbitsa thupi kwa ophunzira azachipatala kuti akonzekere kukumana ndi matenda msanga. Izi zimapereka njira ina yothandiza popewa zopinga zokhudzana ndi kutenga nawo mbali kwa aphunzitsi. Zimathandizanso phindu lowonjezera kwa gulu lophunzitsa ndi ophunzira awo asanayambe kuchita masewera olimbitsa thupi: onse amapindula ndi kuphunzira limodzi. Ubwino wake ndikuwonetsa ophunzira asanayambe kuchita masewera olimbitsa thupi malingaliro osiyanasiyana ndi zitsanzo zogwirira ntchito limodzi [23]. Malingaliro ena omwe amapezeka mu kuphunzira kogwirizana amapanga malo ogwirizana [10] momwe ophunzirawa amapezera chidziwitso kuchokera kuzinthu ziwiri: 1) kinesthetic - kumanga njira zolondola zochitira masewera olimbitsa thupi, 2) kupanga - kumanga kulingalira kozindikira. MS4 amapindulanso ndi kuphunzira kogwirizana, kuwakonzekeretsa ntchito yamtsogolo yophatikizana ndi akatswiri azaumoyo.
Chitsanzo chathu chimaphatikizaponso ubwino wophunzirira anzawo [24]. Ophunzira asanayambe maphunziro amapindula ndi kugwirizana kwa chidziwitso, malo ophunzirira otetezeka, kuyanjana ndi anthu a MS4 ndi chitsanzo, komanso "kuphunzira kawiri" - kuchokera ku zomwe adaphunzira poyamba komanso za ena; Amawonetsanso chitukuko chawo pantchito pophunzitsa anzawo achichepere ndikugwiritsa ntchito mwayi wotsogozedwa ndi aphunzitsi kuti apange ndikukweza luso lawo lophunzitsa ndi mayeso. Kuphatikiza apo, zomwe akumana nazo pophunzitsa zimawakonzekeretsa kukhala aphunzitsi ogwira mtima powaphunzitsa kugwiritsa ntchito njira zophunzitsira zochokera ku umboni.
Maphunziro adaphunziridwa panthawi yogwiritsa ntchito chitsanzochi. Choyamba, ndikofunikira kuzindikira kusokonekera kwa ubale wa maphunziro osiyanasiyana pakati pa MS4 ndi SPI, chifukwa ena samvetsetsa bwino momwe angagwirire ntchito limodzi. Maudindo omveka bwino, mabuku ofotokozera mwatsatanetsatane, ndi misonkhano yamagulu imathetsa mavutowa bwino. Chachiwiri, maphunziro atsatanetsatane ayenera kuperekedwa kuti akonze bwino ntchito zamagulu. Ngakhale kuti magulu onse awiri a alangizi ayenera kuphunzitsidwa kuphunzitsa, SPI iyeneranso kuphunzitsidwa momwe angachitire maluso a mayeso omwe MS4 yadziwa kale. Chachitatu, kukonzekera mosamala ndikofunikira kuti pakhale nthawi yotanganidwa ya MS4 ndikuwonetsetsa kuti gulu lonse lilipo pa gawo lililonse loyesa thupi. Chachinayi, mapulogalamu atsopano akuyembekezeka kukumana ndi kutsutsidwa kuchokera kwa aphunzitsi ndi oyang'anira, ndi mfundo zamphamvu zokomera kugwiritsa ntchito ndalama moyenera;
Mwachidule, chitsanzo cha SPI-MS4 chophunzitsira matenda a thupi chikuyimira njira yapadera komanso yothandiza yophunzirira momwe ophunzira azachipatala angaphunzirire bwino maluso olimbitsa thupi kuchokera kwa omwe si 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 a ophunzira ndi aphunzitsi, chitsanzochi chili ndi kuthekera kogwiritsidwa ntchito kwambiri.
Deta ya kafukufukuyu ikupezeka kwa Dr. Benjamin Blatt, MD, Mtsogoleri wa GWU Study Center. Deta yathu yonse yaperekedwa mu kafukufukuyu.
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Nthawi yotumizira: Meyi-11-2024