Calculated overhaul versus cultivating the status quo in clinical education.
نویسندگان
چکیده
In an era of rapid healthcare evolution, complex challenges abound from changes in patient demographics, diseases, demand and delivery; to cost, technology, and setting.1 Such transformations, bound by political, socioeconomic, cultural, and countless other hurdles, cannot be systematically and strategically met by a workforce whose pedagogy and preparation was intended for a different breed and generation of doctors.2,3 For decades, the approach to clinical education has not fundamentally changed, even as medical education literature has become inundated with calls for reform and restructuring.2,3 Despite a global shift towards shortened inpatient stays and increased ambulatory care, for example, the fi rst clinical year of medical school has retained a block model in which students rotate through discipline-specifi c clerkships. Notwithstanding its history and tradition, the latter model is deemed “poorly aligned with society’s present and future needs”, leading to ill-prepared graduates.2 Among the block clerkship model’s shortcomings are arbitrary structure of largely inpatient rotations, limited outpatient experiences, discontinuous clinical skills development, and lack of continuity, be it with patients or faculty.2 Evidence shows erosion of students’ ethical behaviour, moral reasoning, idealism, empathy, and patientcentred attitudes.4-6 These attributes are often undermined by unintended consequences of the hidden curriculum; one in which espoused and enacted elements of professionalism may be discordant.3 Years of formal training and acquisition of patient-centred skills are easily jeopardised in an environment in which such behaviours are not modelled, hindering development of students’ professional identity.3
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عنوان ژورنال:
- Annals of the Academy of Medicine, Singapore
دوره 43 3 شماره
صفحات -
تاریخ انتشار 2014