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首页> 外文期刊>The Journal of Graduate Medical Education >The Future of Medical Education: Assessing the Impact of Interventions on Long-Term Retention and Clinical Care
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The Future of Medical Education: Assessing the Impact of Interventions on Long-Term Retention and Clinical Care

机译：医学教育的未来：评估干预措施对长期保留和临床护理的影响

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The study reported by Dolan et al1 in this issue of the Journal of Graduate Medical Education epitomizes the type of research that is sorely needed in medical education. The authors conducted a randomized controlled trial in which they assigned internal medicine residents at a large academic practice to receive either the standard curriculum in fracture prevention, or a standard curriculum plus repeated, spaced practice on the material over a 3- to 6-month period. They found that the intervention with repeated practice produced better retention of knowledge 10 months later, and improved the quality of clinical care (bone density screening rates, appropriate use of bisphosphonates, but not FRAX score reporting) provided by the residents during the study. This study is innovative and important in that it assesses the long-term consequences of an educational intervention, and measures its impact on both knowledge and clinical practice. In education at all levels and in all fields, we tend to focus on short-term outcomes. That is, learning is generally assessed during, or immediately after, the time it occurs (eg, questions posed to students during a lecture, quizzes at the end of class, or final examination after a course). Short-term outcomes are important for many reasons, such as formative and summative assessment. However, when we focus exclusively on short-term outcomes, we make an assumption that is often false: we assume that short-term performance is a good predictor of performance over longer periods of time. Unfortunately, mastery demonstrated during or immediately after learning can be easily lost in the following weeks and months without continued practice.2,3 For example, numerous studies have found that a substantial portion of the basic knowledge and skills acquired in medical school is forgotten by the time individuals enter graduate training, let alone practice.4–7 Similar patterns occur in graduate medical education, with residents forgetting knowledge and skills that are fundamental to their training.8–12 One conclusion that can be drawn from studies that assess long-term outcomes is that we can be shortsighted in how we approach educational interventions. We often devote a substantial amount of effort to facilitating initial learning, but comparatively little effort to maintaining it. For example, a recent study13 assessed the short-term and long-term consequences of redesigning a lecture-based, preclinical pediatrics course to incorporate team-based learning, a pedagogical approach that promotes active learning. Through comparing a group that received the lecture-based version of the course to a group that received the team-based learning version, the study tracked student knowledge of core concepts from the course over time. When knowledge was measured after the end of course, the students who had taken the team-based learning version performed substantially better than students in the lecture-based version. However, when students were given a follow-up knowledge assessment prior to their clerkship, the learning gains in the team-based learning group had disappeared, and the 2 groups performed at the same level. Such findings demonstrate how devoting substantial effort to facilitating initial learning can yield benefits, but those benefits can be easily lost without efforts to maintain knowledge and skills afterward. Given that learning gains can be easily lost in the absence of continued practice, how can we help medical students, residents, and other health professionals maintain the knowledge and skills that they acquire during training? The intervention implemented by Dolan and colleagues1 provides a possible template. The intervention incorporates several mechanisms known to promote long-term retention and deeper understanding: retrieval practice, feedback, and spaced repetitions.14,15 Retrieval practice refers to the act of retrieving information from memory (eg, solving a practice problem or answering
机译：Dolan et al1在这个问题上报告了研究生医学教育杂志的研究表明了医学教育中非常需要的研究类型。作者进行了一项随机对照试验，其中他们在大型学术实践中分配了内部医学居民，以接收骨折预防的标准课程，或者标准课程加上重复，在3个月内对材料进行重复的间隔实践。他们发现，在研究期间，重复实践的干预率为10个月内提高了临床护理的质量（骨密度筛选率，适当地使用双膦酸盐，但不是Frax评分报告）。本研究具有创新性，重要的是，它评估了教育干预的长期后果，并对知识和临床实践的影响措施。在各级和所有领域的教育中，我们倾向于关注短期成果。也就是说，通常在期间或之后评估学习，它发生的时间（例如，在讲座期间向学生提出的问题，在课程结束时测验，或在课程后的最终检查）。短期成果因许多原因而言是重要的，例如形成性和总结评估。然而，当我们专注于短期结果时，我们假设通常是假的：我们假设短期表现是较长时间的性能的良好预测因素。不幸的是，在未来几周和几个月内，在没有继续做出的情况下，学习后可以轻易丢失掌握。例如，众多研究发现，在医学院获得的大部分基本知识和技能被遗忘人的时间进入研究生培训，更不用说实践.4-7在研究生医学教育中发生类似的模式，居民忘记了他们的培训基础的知识和技能.8-12一个可以从评估的研究中得出的结论一期术语结果是，我们可以在我们接近教育干预的情况下短视。我们经常致力于促进初始学习的大量努力，但相对努力维护它。例如，最近的一项研究13评估了重新设计讲座，临床前儿科课程的短期和长期后果，以纳入基于团队的学习，这是一种促进积极学习的教学方法。通过将收到基于讲座的课程版本的组与收到基于团队的学习版本的组进行比较，研究跟踪了随着时间的推移从课程中履行核心概念的学生知识。当知识在课程结束后衡量时，那些以基于讲座的版本中的学生们在基于团队的学习版本的学生们进行了大幅度。但是，当学生在职员之前获得后续知识评估时，基于团队的学习组中的学习收益消失，2组在同一级别进行。这样的研究结果表明，促进初始学习的重大努力如何产生益处，但在没有努力维护知识和技能的情况下，这些益处可以很容易地丢失。鉴于在没有持续的实践的情况下，学习收益很容易丢失，我们如何帮助医学生，居民和其他卫生专业人员维护他们在培训期间获得的知识和技能？ Dolan和Conseagues1实施的干预提供了可能的模板。该干预包括若干已知促进长期保留和更深的理解机制：检索实践，反馈和间隔重复.14,15检索实践是指从内存中检索信息的行为（例如，解决实践问题或回答

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