A al'ada, malamai sun koyar da jarrabawar jiki (PE) ga sababbin masu zuwa likita (masu horo), duk da kalubale tare da daukar ma'aikata da farashi, da kuma kalubale tare da daidaitattun dabaru.
Muna ba da shawarar ƙirar da ke amfani da daidaitattun ƙungiyoyi na masu koyar da haƙuri (SPIs) da ɗaliban likitanci na shekara huɗu (MS4s) don koyar da azuzuwan ilimin motsa jiki ga ɗaliban da suka fara aikin likita, suna cin gajiyar haɗin gwiwa da koyon taimakon takwarorinsu.
Binciken da aka yi na kafin-sabis, ɗaliban MS4 da SPI sun bayyana kyakkyawar fahimta game da shirin, tare da ɗaliban MS4 suna ba da rahoton ci gaba mai mahimmanci a cikin ƙwararrun ƙwararrun su a matsayin malamai.Kwarewar ƙwararrun ɗaliban da suka riga sun yi gwajin ƙwarewar asibiti na bazara ya yi daidai da ko mafi kyau fiye da yadda takwarorinsu na shirye-shiryen suka yi.
Ƙungiyar SPI-MS4 za ta iya koya wa ɗalibai novice yadda ya kamata injiniyoyi da tushen asibiti na novice gwajin jiki.
Sabbin ɗaliban likitanci (dalibai kafin likita) suna koyon ainihin gwajin jiki (PE) a farkon makarantar likitanci.Gudanar da azuzuwan ilimin motsa jiki don ɗaliban makarantar share fage.A al'adance, amfani da malamai ma yana da illa, wato: 1) suna da tsada;3) suna da wahalar daukar ma'aikata;4) suna da wuyar daidaitawa;5) nuances na iya tashi;kurakurai da aka rasa da bayyane [1, 2] 6) Maiyuwa bazai saba da hanyoyin koyarwa na tushen shaida [3] 7) Yana iya jin cewa ƙwarewar koyarwa ta ilimin motsa jiki ba ta isa ba [4];
An haɓaka samfuran horar da motsa jiki masu nasara ta amfani da marasa lafiya na gaske [5], manyan ɗaliban likitanci ko mazauna [6, 7], da kuma mutane masu zaman kansu [8] a matsayin masu koyarwa.Yana da mahimmanci a lura cewa duk waɗannan samfuran suna da alaƙa da cewa aikin ɗalibi a cikin darussan ilimin motsa jiki ba ya raguwa saboda keɓancewar halartar malamai [5, 7].Duk da haka, malamai na kwance ba su da kwarewa a cikin mahallin asibiti [9], wanda ke da mahimmanci ga dalibai su sami damar yin amfani da bayanan wasanni don gwada hasashen bincike.Don magance buƙatar daidaitawa da mahallin asibiti a cikin koyarwar ilimin motsa jiki, ƙungiyar malamai sun ƙara darussan bincike da aka yi amfani da su zuwa koyarwar su [10].A Makarantar Magunguna ta Jami'ar George Washington (GWU), muna magance wannan buƙatar ta hanyar samfurin daidaitattun ƙungiyoyi na masu koyar da haƙuri (SPI) da manyan ɗaliban likita (MS4s).(Hoto 1) An haɗa SPI tare da MS4 don koyar da PE ga masu horarwa.SPI tana ba da ƙwarewa a cikin injiniyoyi na gwajin MS4 a cikin mahallin asibiti.Wannan samfurin yana amfani da koyo na haɗin gwiwa, wanda shine kayan aikin ilmantarwa mai ƙarfi [11].Saboda ana amfani da SP a kusan dukkanin makarantun likitancin Amurka da makarantun ƙasa da ƙasa da yawa [12, 13], kuma yawancin makarantun likitanci suna da shirye-shiryen ɗalibai-ɗalibai, wannan ƙirar tana da yuwuwar aikace-aikace mai faɗi.Manufar wannan labarin shine don bayyana wannan keɓaɓɓen samfurin horon ƙungiyar SPI-MS4 (Hoto 1).
Taƙaitaccen bayanin samfurin koyo na haɗin gwiwar MS4-SPI.MS4: Ƙwararren Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru;
Fahimtar ganewar jiki da ake buƙata (PDX) a GWU ɗaya ce daga cikin kwas ɗin ƙwarewar asibiti na farko a cikin magani.Sauran sassan: 1) Haɗin kai na asibiti (zamanin rukuni bisa ka'idar PBL);2) Hira;3) Motsa jiki OSCE;4) Koyarwar asibiti (aikace-aikacen basirar asibiti ta hanyar ƙwararrun likitoci);5) Koyawa don haɓaka sana'a;PDX tana aiki a cikin ƙungiyoyin masu horarwa 4-5 waɗanda ke aiki akan ƙungiyar SPI-MS4 iri ɗaya, suna saduwa sau 6 a shekara don awanni 3 kowace.Girman aji shine kusan ɗalibai 180, kuma kowace shekara ana zaɓar ɗaliban MS4 60 zuwa 90 a matsayin malamai don darussan PDX.
MS4s suna karɓar horon malamai ta hanyar TALKS (Ilimin Koyarwa da Ƙwarewa) zaɓaɓɓen malami na ci gaba, wanda ya haɗa da bita kan ƙa'idodin ilmantarwa na manya, ƙwarewar koyarwa, da bayar da amsa [14].SPIs suna fuskantar babban shirin horo na dogon lokaci wanda Mataimakin Daraktan Cibiyar Simulation na CLASS (JO) ya haɓaka.An tsara kwasa-kwasan SP a kusa da jagororin da malamai suka haɓaka waɗanda suka haɗa da ƙa'idodin koyo na manya, salon koyo, da jagoranci na rukuni da kuzari.Musamman, horarwar SPI da daidaitawa suna faruwa a matakai da yawa, farawa a lokacin rani kuma ana ci gaba a cikin shekarar makaranta.Darussan sun haɗa da yadda ake koyarwa, sadarwa da gudanar da azuzuwan;yadda darasin ya dace da sauran karatun;yadda ake ba da amsa;yadda ake gudanar da motsa jiki da koyar da su ga dalibai.Don tantance cancantar shirin, SPI dole ne su wuce gwajin wuri wanda memba na SP ke gudanarwa.
MS4 da SPI suma sun halarci taron bita na sa'o'i biyu tare don bayyana irin rawar da suke takawa wajen tsarawa da aiwatar da manhajoji da tantance daliban da ke shiga horon kafin aiki.Tushen tsarin bitar shine samfurin GRPI (manufofin, matsayi, matakai da abubuwan haɗin kai) da ka'idar Mezirow na ilmantarwa canji (tsari, wurare da abun ciki) don koyar da ra'ayoyin koyo na tsaka-tsaki (ƙari) [15, 16].Yin aiki tare a matsayin malamai na haɗin gwiwa ya dace da zamantakewar zamantakewa da ka'idodin ilmantarwa: an halicci ilmantarwa a cikin musayar zamantakewa tsakanin membobin ƙungiya [17].
An tsara tsarin karatun PDX a kusa da tsarin Core da Clusters (C+C) [18] don koyar da PE a cikin mahallin tunanin asibiti sama da watanni 18, tare da kowane tsarin karatun tari ya mai da hankali kan gabatarwar haƙuri na yau da kullun.Dalibai za su fara nazarin sashin farko na C+C, jarrabawar mota mai tambaya 40 wanda ke rufe manyan sassan gabobin.Jarabawar asali gwaji ce mai sauƙi kuma mai amfani wacce ba ta da harajin fahimi fiye da jarrabawar gama gari ta gargajiya.Babban jarrabawa shine manufa don shirya ɗalibai don ƙwarewar asibiti na farko kuma makarantu da yawa sun yarda da su.Studentsalibai suna matsa zuwa bangarorin biyu na C + C, gurbi na tantancewa, wanda shine rukuni na Hypothen-Hypothen-Hypothen-Tripten-Hypoten Hypication na Castical da aka tsara don haɓaka ƙwarewar asibiti.Ciwon ƙirji shine misalin irin wannan bayyanar asibiti (Table 1).Tari suna fitar da mahimman ayyuka daga gwajin farko (misali, haɓakar zuciya na asali) kuma suna ƙara ƙarin ayyuka na musamman waɗanda ke taimakawa bambance iyawar ganowa (misali, sauraron ƙarin sautin zuciya a matsayi na decubitus na gefe).Ana koyar da C+C na tsawon watanni 18 kuma tsarin karatun yana ci gaba, tare da fara horar da ɗalibai a cikin kusan gwaje-gwajen motsa jiki guda 40 sannan, lokacin da aka shirya, suna ƙaura zuwa ƙungiyoyi, kowanne yana nuna aikin asibiti wanda ke wakiltar tsarin tsarin gabobin.abubuwan da ɗalibin ya fuskanta (misali, ciwon ƙirji da ƙarancin numfashi yayin toshewar zuciya) (Table 2).
A cikin shirye-shiryen kwas ɗin PDX, ɗaliban pre-doctoral suna koyon ƙa'idodin bincike da suka dace (Hoto 2) da horo na jiki a cikin littafin PDX, littafin bincike na jiki, da bidiyoyin bayani.Jimlar lokacin da ake buƙata don ɗalibai don shirya kwas ɗin kusan mintuna 60-90 ne.Ya haɗa da karanta Fakitin Cluster (shafukan 12), karanta babin Bates (~ shafuffuka 20), da kallon bidiyo (minti 2-6) [19].Ƙungiyar MS4-SPI tana gudanar da tarurruka a daidaitattun hanyoyi ta amfani da tsarin da aka ƙayyade a cikin littafin (Table 1).Suna fara yin gwajin baka (yawanci tambayoyin 5-7) akan ilimin farko (misali, menene ilimin lissafin jiki da mahimmancin S3? Menene ganewar asali yana goyan bayan kasancewarsa a cikin marasa lafiya da ƙarancin numfashi?).Daga nan sai su sake nazarin ka'idojin bincike da share shakku na daliban da ke shiga horon share fage.Sauran karatun shine atisayen karshe.Na farko, ɗalibai suna shirye-shiryen yin motsa jiki na motsa jiki akan junansu da kan SPI kuma suna ba da amsa ga ƙungiyar.A ƙarshe, SPI ta gabatar musu da wani bincike kan "Ƙananan Tsarin OSCE."Dalibai sun yi aiki bi-biyu don karanta labarin kuma suna ba da shawara game da ayyukan nuna wariya da aka yi akan SPI.Sa'an nan, bisa sakamakon simintin kimiyyar lissafi, ɗaliban da suka riga sun kammala karatun digiri sun gabatar da hasashe kuma suna ba da shawarar yiwuwar ganewar asali.Bayan kwas ɗin, ƙungiyar SPI-MS4 ta tantance kowane ɗalibi sannan ta gudanar da kimantawa da gano wuraren da za a inganta don horo na gaba (Table 1).Sake mayar da martani shine muhimmin kashi na kwas.SPI da MS4 suna ba da ra'ayi na kan-da- tashi yayin kowane zama: 1) yayin da ɗalibai ke yin motsa jiki akan juna da kuma kan SPI 2) yayin Mini-OSCE, SPI tana mai da hankali kan injiniyoyi kuma MS4 tana mai da hankali kan tunanin asibiti;SPI da MS4 kuma suna ba da taƙaitaccen bayani a rubuce a ƙarshen kowane semester.An shigar da wannan ra'ayi na yau da kullun a cikin tsarin sarrafa ilimin likitanci akan layi a ƙarshen kowane zangon karatu kuma yana shafar matakin ƙarshe.
Daliban da ke shirye-shiryen horarwa sun bayyana ra'ayoyinsu game da gogewar da aka samu a cikin wani bincike da Sashen Nazarin Ilimi da Ilimi na Jami'ar George Washington suka gudanar.Kashi 97 cikin 100 na ɗaliban da suka kammala karatun digiri sun yarda sosai ko kuma sun yarda cewa kwas ɗin gwajin jiki yana da mahimmanci kuma sun haɗa da sharhi:
“Na yi imani da cewa darussan bincike na jiki sune mafi kyawun ilimin likitanci;misali, lokacin da kuke koyarwa ta fuskar ɗalibi na huɗu da haƙuri, kayan sun dace kuma ana ƙarfafa su ta hanyar abin da ake yi a cikin aji.
"SPI tana ba da kyakkyawar shawara game da hanyoyi masu amfani don aiwatar da hanyoyi kuma suna ba da kyakkyawar shawara game da nuances wanda zai iya haifar da rashin jin daɗi ga marasa lafiya."
“SPI da MS4 suna aiki tare da kyau kuma suna ba da sabon hangen nesa kan koyarwa mai mahimmanci.MS4 yana ba da haske game da manufofin koyarwa a aikin asibiti.
“Ina so mu yawaita saduwa.Wannan shi ne ɓangaren da na fi so na kwas ɗin aikin likita kuma ina jin kamar ya ƙare da sauri."
Daga cikin masu amsawa, 100% na SPI (N = 16 [100%) da MS4 (N = 44 [77%) sun ce kwarewarsu a matsayin mai koyar da PDX yana da kyau;91% da 93%, bi da bi, na SPIs da MS4s sun ce suna da kwarewa a matsayin malami na PDX;kyakkyawar kwarewa ta yin aiki tare.
Binciken mu na ingancin halayen MS4 na abin da suka daraja a cikin abubuwan da suka koya a matsayin malamai ya haifar da jigogi masu zuwa: 1) Aiwatar da ka'idar ilmantarwa ta manya: ƙarfafa ɗalibai da ƙirƙirar yanayin koyo mai aminci.2) Shirye-shiryen koyarwa: tsara aikace-aikacen asibiti da suka dace, tsammanin tambayoyin masu horarwa, da haɗin kai don samun amsoshi;3) Samfuran ƙwarewa;4) Wucewa da tsammanin: isa da wuri da barin marigayi;5) Sake mayar da martani: ba da fifiko akan lokaci, mai ma'ana, ƙarfafawa da amsawa mai mahimmanci;Samar da masu horarwa da shawarwari game da halayen karatu, yadda mafi kyawun kammala darussan tantancewar jiki, da shawarwarin aiki.
Daliban gidauniya suna shiga jarrabawar OSCE mai kashi uku na ƙarshe a ƙarshen semester na bazara.Don kimanta tasirin shirinmu, mun kwatanta aikin ƙwararrun ɗalibai a fannin ilimin lissafi na OSCE kafin da kuma bayan ƙaddamar da shirin a cikin 2010. Kafin 2010, malaman likitocin MS4 sun koyar da PDX ga ɗaliban da ke karatun digiri.Ban da shekarar mika mulki ta 2010, mun kwatanta alamun bazara na OSCE don ilimin motsa jiki na 2007-2009 tare da alamomi na 2011-2014.Adadin ɗaliban da ke shiga cikin OSCE sun kasance daga 170 zuwa 185 a kowace shekara: ɗalibai 532 a cikin rukunin riga-kafi da ɗalibai 714 a cikin ƙungiyar bayan shiga tsakani.
Makin OSCE daga 2007-2009 da 2011-2014 jarrabawar bazara an tattara su, ana auna su da girman samfurin shekara-shekara.Yi amfani da samfuran 2 don kwatanta tarin GPA na kowace shekara na lokacin da ta gabata tare da tarin GPA na ƙarshen zamani ta amfani da t-gwajin.GW IRB ta keɓe wannan binciken kuma ta sami izinin ɗalibi don yin amfani da bayanan ilimin su don binciken ba tare da suna ba.
Ma'anar ɓangaren gwajin jiki ya karu sosai daga 83.4 (SD = 7.3, n = 532) kafin shirin zuwa 89.9 (SD = 8.6, n = 714) bayan shirin (ma'anar canji = 6, 5; 95% CI: 5.6 zuwa 7.4; p<0.0001) (Table 3).Koyaya, tunda sauye-sauye daga koyarwa zuwa ma'aikatan da ba koyarwa sun zo daidai da canje-canje a cikin manhaja, bambance-bambance a maki OSCE ba za a iya bayyana su karara ta hanyar sabbin abubuwa ba.
Samfurin koyarwa na ƙungiyar SPI-MS4 wata sabuwar hanya ce ta koyar da ilimin ilimin motsa jiki na asali ga ɗaliban likitanci don shirya su don bayyanar asibiti da wuri.Wannan yana ba da ingantacciyar hanya ta ƙetare shingen da ke tattare da sa hannun malamai.Hakanan yana ba da ƙarin ƙima ga ƙungiyar koyarwa da ɗaliban da suka fara aiki: duk suna amfana daga koyo tare.Fa'idodin sun haɗa da fallasa ɗalibai kafin yin aiki zuwa ra'ayoyi daban-daban da abin koyi don haɗin gwiwa [23].Madadin ra'ayoyin da ke cikin ilmantarwa na haɗin gwiwa suna haifar da yanayi mai ginawa [10] wanda waɗannan ɗalibai ke samun ilimi daga tushe guda biyu: 1) kinesthetic - gina ingantattun dabarun motsa jiki na jiki, 2) roba - gina dalilan bincike.MS4s kuma suna amfana daga koyo na haɗin gwiwa, shirya su don aikin tsaka-tsakin lokaci na gaba tare da ƙwararrun kiwon lafiya.
Misalinmu kuma ya haɗa da fa'idodin ilmantarwa na tsara [24].Daliban riga-kafi suna amfana daga daidaitawar fahimi, ingantaccen yanayin koyo, zamantakewar MS4 da yin koyi, da “koyo biyu”—daga nasu koyo na farko da na wasu;Suna kuma nuna ci gaban sana'arsu ta hanyar koyar da ƴan takwarorinsu da kuma yin amfani da damar da malamai ke jagoranta don haɓakawa da haɓaka ƙwarewar koyarwa da jarrabawa.Bugu da ƙari, ƙwarewar koyarwarsu tana shirya su don zama ƙwararrun malamai ta hanyar horar da su don amfani da hanyoyin koyarwa na tushen shaida.
An koyi darussa yayin aiwatar da wannan samfurin.Na farko, yana da mahimmanci a gane sarƙaƙƙiyar dangantakar da ke tsakanin MS4 da SPI, saboda wasu dyads ba su da cikakkiyar fahimtar yadda za a yi aiki tare.Tabbatattun ayyuka, dalla-dalla littattafai da taron bita na rukuni suna magance waɗannan batutuwa yadda ya kamata.Na biyu, dole ne a ba da cikakken horo don inganta ayyukan ƙungiyar.Duk da yake dole ne a horar da rukunonin malamai guda biyu don koyarwa, SPI kuma tana buƙatar horar da su kan yadda ake gudanar da ƙwarewar jarrabawar da MS4 ta riga ta ƙware.Na uku, ana buƙatar yin shiri a hankali don ɗaukar jadawalin aiki na MS4 da kuma tabbatar da cewa duka ƙungiyar suna nan don kowane zaman kima na jiki.Na hudu, ana sa ran sabbin shirye-shirye za su fuskanci juriya daga malamai da gudanarwa, tare da hujjoji masu karfi don goyon bayan farashi;
A taƙaice, ƙirar koyarwa ta jiki ta SPI-MS4 tana wakiltar keɓantacce kuma ingantaccen tsarin karatu wanda ɗaliban likitanci za su iya samun nasarar koyan ƙwarewar jiki daga ƙwararrun ƙwararrun likitoci.Tunda kusan dukkanin makarantun likitanci a Amurka da yawancin makarantun likitancin ƙasashen waje suna amfani da SP, kuma yawancin makarantun likitanci suna da shirye-shiryen ɗalibai-ɗalibai, wannan ƙirar tana da yuwuwar aikace-aikacen fa'ida.
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