Early practical experience and the social responsiveness of clinical education: systematic review

Abstract

Objectives To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence. Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations. Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Examen clínico objetivo y estructurado formativo tras inmersión clínica precoz empleando estudiantes de sexto curso como observadores y administradores de retroalimentación

“…Varios estudios han demostrado que los estudiantes se sienten poco preparados para empezar las rotaciones clínicas formales y encuentran la conversión de uno a otro tipo de aprendizaje abrumador y particularmente estresante [1,3,4,6,7].…”

“…Con o sin curso de transición previo, las rotaciones clínicas precoces se han introducido en los nuevos currículos tanto en su forma llamada 'débil' (contactos ocasionales con pacientes) como de manera formal, con el objetivo de aliviar la ansiedad y mejorar el rendimiento de los estudiantes en las rotaciones formales programadas para el periodo clí-nico [2][3][4][5]13,14]. Diferentes estudios indican que los contactos clínicos precoces motivan y estimulan de diferentes maneras a los estudiantes al mostrarles por vez primera la relevancia práctica de la teoría que aprenden, propulsar su autoconfianza y ayudarles a iniciar el desarrollo de su identidad profesional y las habilidades de relación interpersonal [3,13,14].…”

“…Diferentes estudios indican que los contactos clínicos precoces motivan y estimulan de diferentes maneras a los estudiantes al mostrarles por vez primera la relevancia práctica de la teoría que aprenden, propulsar su autoconfianza y ayudarles a iniciar el desarrollo de su identidad profesional y las habilidades de relación interpersonal [3,13,14].…”

“…La inmersión clínica representa un paso crítico en los estudios de medicina porque proporciona el primer contacto continuado del alumno con el paciente en el contexto clínico [1][2][3][4][5]. Dado que en nuestro currículo las rotaciones clínicas formales no se inician hasta cuarto curso, pareció conveniente adelantar la exposición clínica de los estudiantes al inicio del tercer curso.…”

Role models, radicals, and reactionaries

“…This should include exposure to the neglected, chaotic, and the disenfranchised among our society as well as to those sectors which are easier to engage with. 3 Perhaps above all, we should recall the enthusiasm and passion that we had at the outset and which we hopefully still retain despite the mortgage and the politics. We should remember what it was like to watch others at work and remember that one day they will be sitting in the other seat with someone watching them.…”