Ko ngā tikanga tuku iho, ko te whakamātautau tinana (PE) te kaupapa matua a ngā kaiako ki ngā tauhou hauora (ngā tauira), ahakoa ngā wero o te kimi kaimahi me ngā utu, tae atu ki ngā wero o ngā tikanga paerewa.
Ka whakaarohia e mātou he tauira e whakamahi ana i ngā tīma kaiako tūroro (SPI) me ngā ākonga hauora tau tuawhā (MS4) hei whakaako i ngā akomanga mātauranga tinana ki ngā ākonga hauora-mua, me te whakamahi pai i te ako tahi me te ako āwhina-a-hoa.
I whakaatuhia e ngā rangahau o ngā ākonga o mua i te kura, MS4 me SPI ngā tirohanga pai mō te kaupapa, me ngā ākonga MS4 e kī ana he nui ngā whakapainga i roto i tō rātou tuakiri ngaio hei kaiwhakaako. Ko te mahi a ngā ākonga o mua i te kura i ngā whakamātautau pūkenga haumanu o te puna he rite, he pai ake rānei i te mahi a ō rātou hoa o mua i te kura.
Ka taea e te tīma SPI-MS4 te whakaako i ngā ākonga tauhou ki ngā tikanga me ngā pūtake haumanu o te whakamātautau tinana o te tauhou.
Ka ako ngā ākonga hauora hou (ngā ākonga o mua i te kura hauora) i te whakamātautau tinana taketake (PE) i te tīmatanga o te kura hauora. Ka whakahaerehia ngā akomanga mātauranga tinana mō ngā ākonga kura whakarite. I ngā wā o mua, he ngoikoretanga anō hoki te whakamahi i ngā kaiako, arā: 1) he utu nui; 3) he uaua ki te kimi; 4) he uaua ki te whakataurite; 5) tera pea ka ara ake ngā āhuatanga rerekē; he hapa ngaro, he hapa kitea [1, 2] 6) Kāore pea i te mōhio ki ngā tikanga whakaako e ahu mai ana i ngā taunakitanga [3] 7) Tērā pea ka whakaaro kāore i te rawaka ngā pūkenga whakaako mātauranga tinana [4];
Kua whakawhanakehia ngā tauira whakangungu whakakori tinana angitu mā te whakamahi i ngā tūroro tūturu [5], ngā tauira hauora matua, ngā tauira noho rānei [6, 7], me ngā tāngata noa [8] hei kaiako. He mea nui kia mōhio ko te āhuatanga ōrite o ēnei tauira katoa ko te kore e heke te mahi a ngā ākonga i roto i ngā akoranga ako tinana nā te korenga o te whai wāhi a ngā kaiako [5, 7]. Heoi, kāore i te nui te wheako o ngā kaiako noa i roto i te horopaki haumanu [9], he mea nui kia taea e ngā ākonga te whakamahi i ngā raraunga hākinakina hei whakamātautau i ngā whakapae tātaritanga. Hei aro atu ki te hiahia mō te paerewa me te horopaki haumanu i roto i te whakaakoranga ako tinana, i tāpirihia e tētahi rōpū kaiako ngā mahi tātaritanga e ārahihia ana e ngā whakapae ki ā rātou whakaakoranga noa [10]. I te Kura Rongoā o Te Whare Wānanga o George Washington (GWU), kei te aro atu mātou ki tēnei hiahia mā roto i tētahi tauira o ngā rōpū kaiako tūroro paerewa (SPI) me ngā tauira hauora matua (MS4). (Pikitia 1) Ka honoa te SPI me te MS4 ki te whakaako i te PE ki ngā ākonga whakangungu. Ka whakaratohia e te SPI te tohungatanga ki ngā tikanga o te whakamātautau MS4 i roto i te horopaki haumanu. Ka whakamahia e tēnei tauira te ako tahi, he taputapu ako kaha [11]. Nā te mea e whakamahia ana te SP i roto i te nuinga o ngā kura hauora o Amerika me te maha o ngā kura o te ao [12, 13], ā, he maha ngā kura hauora he kaupapa mō ngā ākonga me ngā kaiako, ka taea te whakamahi whānui i tēnei tauira. Ko te kaupapa o tēnei tuhinga he whakaahua i tēnei tauira whakangungu hākinakina tīma SPI-MS4 ahurei (Pikitia 1).
He whakamārama poto mō te tauira ako mahi tahi MS4-SPI. MS4: Tauira Hauora Tau Tuawhā SPI: Kaiako Tūroro Paerewa;
Ko te tātaritanga tinana e hiahiatia ana (PDX) i GWU tētahi wāhanga o te akoranga pūkenga haumanu i mua i te mahi kaimahi i roto i te rongoā. Ētahi atu wāhanga: 1) Whakaurunga haumanu (ngā wātū rōpū i runga i te mātāpono PBL); 2) Uiuitanga; 3) Ngā mahi whakawhanake OSCE; 4) Whakangungu haumanu (te whakamahi i ngā pūkenga haumanu e ngā tākuta mahi); 5) Te whakangungu mō te whanaketanga ngaio; Ka mahi a PDX i roto i ngā rōpū o te 4-5 ngā ākonga e mahi ana i runga i te tīma SPI-MS4 kotahi, ka hui 6 ngā wā i te tau mō te 3 hāora ia akomanga. Tata ki te 180 ngā ākonga te rahi o te akomanga, ā, i ia tau kei waenganui i te 60 me te 90 ngā ākonga MS4 ka tohua hei kaiako mō ngā akoranga PDX.
Ka whiwhi ngā MS4 i te whakangungu kaiako mā roto i tā mātou kaupapa whiriwhiri kaiako matatau TALKS (Teaching Knowledge and Skills), tae atu ki ngā awheawhe mō ngā mātāpono ako pakeke, ngā pūkenga whakaako, me te tuku urupare [14]. Ka whai wāhi ngā SPI ki tētahi kaupapa whakangungu roa kaha i whakawhanakehia e tā mātou Kaiwhakahaere Tuarua o te CLASS Simulation Center (JO). Ko ngā akoranga SP he mea hanga i runga i ngā aratohu i whakawhanakehia e ngā kaiako e uru ana ki ngā mātāpono o te ako pakeke, ngā momo ako, me te kaiārahi rōpū me te hihiri. Ina koa, ka puta te whakangungu me te paerewa SPI i roto i ētahi wāhanga, ka tīmata i te raumati ka haere tonu puta noa i te tau kura. Kei roto i ngā akoranga te pehea ki te whakaako, te whakawhitiwhiti kōrero me te whakahaere akomanga; me pēhea te uru o te akoranga ki te toenga o te akoranga; me pēhea te tuku urupare; me pēhea te whakahaere i ngā mahi whakakori tinana me te whakaako i aua mea ki ngā ākonga. Hei aromatawai i te matatau mō te kaupapa, me paahitia e ngā SPI tētahi whakamātautau whakanoho e whakahaerehia ana e te mema kaiako SP.
I whai wāhi atu hoki a MS4 me SPI ki tētahi awheawhe tīma e rua hāora te roa hei whakaahua i ō rāua tūranga tautoko i roto i te whakamahere me te whakatinana i te marautanga me te aromatawai i ngā ākonga e uru ana ki te whakangungu whakangungu-mua. Ko te hanganga taketake o te awheawhe ko te tauira GRPI (ngā whāinga, ngā tūranga, ngā tukanga me ngā āhuatanga whakawhitiwhiti kōrero) me te ariā a Mezirow mō te ako whakawhiti (tukanga, kaupapa me ngā ihirangi) mō te whakaako i ngā ariā ako whakawhitiwhiti mātauranga (tāpiri) [15, 16]. Ko te mahi tahi hei kaiako tahi he rite ki ngā ariā ako pāpori me ngā ariā ako wheako: ka hangaia te ako i roto i ngā whakawhitiwhiti pāpori i waenga i ngā mema o te tīma [17].
Ko te marautanga PDX he mea hanga i runga i te tauira Matua me ngā Rōpū (C+C) [18] hei whakaako i te PE i roto i te horopaki o te whakaaro haumanu mō ngā marama 18, me te arotahi o ia rōpū ki ngā whakaaturanga tūroro noa. Ka ako tuatahi ngā ākonga i te wāhanga tuatahi o te C+C, he whakamātautau nekeneke 40-pātai e kapi ana i ngā pūnaha okana nui. Ko te whakamātautau turanga he whakamātautau tinana māmā me te mahi, he iti ake te uaua o te hinengaro i te whakamātautau whānui tuku iho. He pai ngā whakamātautau matua mō te whakarite i ngā ākonga mō ngā wheako haumanu tōmua, ā, e whakaaetia ana e te maha o ngā kura. Kātahi ka neke ngā ākonga ki te wāhanga tuarua o te C+C, te Rōpū Tātaritanga, he rōpū o ngā H&P e peia ana e te whakapae kua whakaritea i runga i ngā whakaaturanga haumanu whānui motuhake kua hangaia hei whakawhanake i ngā pūkenga whakaaro haumanu. Ko te mamae o te uma he tauira o taua whakaaturanga haumanu (Ripanga 1). Ka tangohia e ngā rōpū ngā mahi matua mai i te whakamātautau tuatahi (hei tauira, te whakarongo ngakau taketake) ka tāpirihia he mahi motuhake hei āwhina i te wehewehe i ngā āheinga tātaritanga (hei tauira, te whakarongo mō ngā oro ngakau tāpiri i te tūranga decubitus taha). E whakaakona ana te C+C mō te wā 18 marama, ā, he kaupapa tonu te marautanga, me te whakangungu tuatahi i ngā ākonga ki te 40 whakamātautau matua o te nekenekehanga, kātahi ka neke ki ngā rōpū, ia rōpū e whakaatu ana i te mahi haumanu e tohu ana i tētahi waeine pūnaha okana. ka pā ki te ākonga (hei tauira, te mamae o te uma me te poto o te manawa i te wā e aukati ana te manawa) (Ripanga 2).
Hei whakarite mō te akoranga PDX, ka ako ngā ākonga o mua i te tohu kairangi i ngā tikanga tātaritanga tika (Pikitia 2) me te whakangungu tinana i roto i te pukapuka ā-ringa PDX, te pukapuka ako tātaritanga tinana, me ngā ataata whakamārama. Ko te roanga katoa e hiahiatia ana mō ngā ākonga ki te whakarite mō te akoranga he tata ki te 60-90 meneti. Kei roto ko te pānui i te Cluster Packet (12 whārangi), te pānui i te upoko o Bates (~20 whārangi), me te mātaki i tētahi ataata (2–6 meneti) [19]. Ka whakahaerehia e te tīma MS4-SPI ngā hui i runga i te tikanga ōrite mā te whakamahi i te whakatakotoranga kua tohua i roto i te pukapuka ā-ringa (Ripanga 1). Tuatahi ka whakamātauhia e rātou he whakamātautau ā-waha (he 5-7 ngā pātai te nuinga) mō ngā mōhiotanga o mua i te wā (hei tauira, he aha te āhua o te tinana me te hiranga o te S3? He aha te tātaritanga e tautoko ana i tōna aroaro i roto i ngā tūroro he poto te manawa?). Kātahi ka arotakehia e rātou ngā tikanga tātaritanga, ā, ka whakamāramahia ngā feaa o ngā ākonga e uru ana ki te whakangungu o mua i te tohu paerua. Ko te toenga o te akoranga he mahi whakamutunga. Tuatahi, ka whakaharatau ngā ākonga e whakarite ana mō te mahi i ngā mahi tinana ki a rātou anō me te SPI, ā, ka tukuna he urupare ki te tīma. Hei whakamutunga, ka tukuna e SPI ki a rātou he rangahau take mō te "Small Formative OSCE." I mahi takirua ngā ākonga ki te pānui i te pūrākau, me te whakatau i ngā mahi wehewehe i mahia i runga i te SPI. Kātahi, i runga i ngā hua o te whakatauira ahupūngao, ka whakatakotohia e ngā ākonga paetahi ngā whakapae me te whakaaro i te tātaritanga tino pea. I muri i te akoranga, i aromatawaihia e te tīma SPI-MS4 ia ākonga, kātahi ka whakahaerehia he aromatawai-whaiaro, ā, ka tautuhia ngā wāhi hei whakapai ake mō te whakangungu e whai ake nei (Ripanga 1). He mea nui te urupare o te akoranga. Ka whakaratohia e te SPI me te MS4 he urupare whakawhanake i ia wā: 1) i a ngā ākonga e mahi ana i ngā mahi ki a rātou anō me te SPI 2) i te wā Mini-OSCE, ka arotahi te SPI ki ngā mahi miihini, ā, ka arotahi te MS4 ki ngā whakaaro haumanu; ka whakaratohia hoki e te SPI me te MS4 he urupare whakamutunga tuhituhi whaimana i te mutunga o ia wāhanga ako. Ka whakaurua tēnei urupare whaimana ki roto i te rubric pūnaha whakahaere mātauranga hauora ipurangi i te mutunga o ia wāhanga ako, ā, ka pā ki te māka whakamutunga.
I roto i tētahi rangahau i whakahaerehia e te Tari Aromatawai me te Rangahau Mātauranga o Te Whare Wānanga o George Washington, i whakapuakihia e ngā ākonga e whakarite ana mō ngā mahi tauira ō rātou whakaaro mō te wheako. E iwa tekau mā whitu ōrau o ngā ākonga paetahi i tino whakaae, i whakaae rānei he mea nui te akoranga tātaritanga tinana, ā, i whakaurua hoki ngā kōrero whakaahua:
"Ki taku whakaaro ko ngā akoranga tātaritanga tinana te mātauranga hauora pai rawa atu; hei tauira, ina whakaako koe mai i te tirohanga a te ākonga tau tuawhā me te tūroro, he mea whai tikanga ngā rauemi, ā, he mea whakakaha ake e ngā mea e mahia ana i roto i te akomanga."
"He tino pai ngā tohutohu a te SPI mō ngā huarahi whai hua hei whakahaere i ngā tikanga, ā, he tino pai hoki ngā kōrero mō ngā āhuatanga rerekē ka pā kino pea ki ngā tūroro."
"He pai te mahi tahi a SPI me MS4, ā, ka whakaratohia he tirohanga hou mō te whakaako, he mea tino whai hua. Ka whakaratohia e MS4 he māramatanga ki ngā whāinga o te whakaako i roto i te mahi haumanu."
"Ko taku hiahia kia maha ake tā tāua hui. Koinei te wāhanga tino pai ki ahau o te akoranga mahi hauora, ā, ki taku whakaaro he tere rawa te mutunga."
I roto i ngā kaiwhakautu, 100% o ngā SPI (N=16 [100%]) me MS4 (N=44 [77%]) i kī he pai ō rātou wheako hei kaiako PDX; 91% me 93%, ia, o ngā SPI me ngā MS4 i kī he wheako ō rātou hei kaiako PDX; he wheako pai ki te mahi tahi.
Nā tā mātou tātaritanga kounga i ngā whakaaro o MS4 mō ngā mea i whakanuia e rātou i roto i ō rātou wheako hei kaiako i hua ake ai ēnei kaupapa: 1) Te whakatinana i te ariā ako pakeke: te whakatenatena i ngā ākonga me te waihanga i tētahi taiao ako haumaru. 2) Te whakarite ki te whakaako: te whakamahere i ngā tono haumanu tika, te matapae i ngā pātai a ngā ākonga, me te mahi tahi ki te kimi whakautu; 3) Te whakatauira i te ngaiotanga; 4) Te hipa i ngā tumanakohanga: te tae wawe me te wehe atu i te mutunga; 5) Te urupare: te whakarite i ngā urupare wā tika, whai tikanga, whakakaha me te hanga; Te whakarato tohutohu ki ngā ākonga mō ngā tikanga ako, me pēhea te whakaoti pai i ngā akoranga aromatawai tinana, me ngā tohutohu mahi.
Ka whai wāhi ngā ākonga turanga ki tētahi whakamātautau OSCE whakamutunga e toru ngā wāhanga i te mutunga o te wāhanga ako o te puna. Hei aromatawai i te whai huatanga o tā mātou kaupapa, i whakaritea e mātou te mahi a ngā ākonga tauira mahi i te wāhanga ahupūngao o te OSCE i mua atu, ā, i muri mai i te whakarewatanga o te kaupapa i te tau 2010. I mua i te tau 2010, i whakaako ngā kaiako rata MS4 i te PDX ki ngā ākonga paetahi. Haunga te tau whakawhiti 2010, i whakaritea e mātou ngā tohu puna OSCE mō te mātauranga tinana mō te tau 2007–2009 me ngā tohu mō te tau 2011–2014. Ko te maha o ngā ākonga i whai wāhi ki te OSCE i waenga i te 170 ki te 185 i ia tau: 532 ngā ākonga i roto i te rōpū i mua i te wawaotanga me te 714 ngā ākonga i roto i te rōpū i muri i te wawaotanga.
Ka whakarapopototia ngā kaute OSCE mai i ngā whakamātautau puna 2007–2009 me 2011–2014, ka paunatia mā te rahi o te tauira ā-tau. Whakamahia kia rua ngā tauira hei whakatairite i te GPA tāpiri o ia tau o te wā o mua ki te GPA tāpiri o te wā o muri mai mā te whakamahi i te whakamātautau-t. I whakakorehia tēnei rangahau e te GW IRB, ā, i whiwhi whakaaetanga ngā ākonga ki te whakamahi i ā rātou raraunga mātauranga mō te rangahau.
I tino piki ake te kaute toharite mō te wāhanga whakamātautau tinana mai i te 83.4 (SD=7.3, n=532) i mua i te kaupapa ki te 89.9 (SD=8.6, n=714) i muri i te kaupapa (te huringa toharite = 6, 5; 95% CI: 5.6 ki te 7.4; p<0.0001) (Ripanga 3). Heoi, nā te mea ko te whakawhiti mai i te kaiako ki te kore-kaiako e taurite ana ki ngā huringa o te marautanga, kāore e taea te whakamārama mārama i ngā rerekētanga o ngā kaute OSCE mā te auahatanga.
Ko te tauira whakaako a te tīma SPI-MS4 he huarahi auaha ki te whakaako i ngā mātauranga tinana taketake ki ngā ākonga hauora hei whakarite i a rātou mō te whakaaturanga haumanu wawe. Mā tēnei ka whai hua te huarahi kē atu mā te karo i ngā arai e pā ana ki te whai wāhi a ngā kaiako. Ka whakaratohia hoki he uara tāpiri ki te tīma whakaako me ā rātou ākonga i mua i te mahi: ka whai hua katoa rātou i te ako tahi. Ko ngā painga ko te whakaatu i ngā ākonga i mua i te mahi ki ngā tirohanga rerekē me ngā tauira mō te mahi tahi [23]. Ko ngā tirohanga kē atu i roto i te ako tahi ka hanga i tētahi taiao hangahanga [10] e whiwhi ai ēnei ākonga i te mātauranga mai i ngā pūtake rua: 1) kinesthetic – te hanga tikanga whakakori tinana tika, 2) synthetic – te hanga whakaaro tātaritanga. Ka whai hua hoki ngā MS4 i te ako tahi, e whakarite ana i a rātou mō ngā mahi ā-wāhanga ā muri ake nei me ngā tohunga hauora tautoko.
Kei roto hoki i tā mātou tauira ngā painga o te ako ā-hoa [24]. Ka whai hua ngā ākonga o mua i te whakangungu i te whakahāngai hinengaro, te taiao ako haumaru, te whakahoahoa me te whakatauira i ngā mahi MS4, me te "ako takirua" - mai i ā rātou ake akoranga tuatahi me ērā atu; Ka whakaatu hoki rātou i tō rātou whanaketanga ngaio mā te whakaako i ngā hoa taitamariki, ā, ka whakamahi i ngā whai wāhitanga e arahina ana e te kaiako hei whakawhanake me te whakapai ake i ō rātou pūkenga whakaako me te whakamātautau. Hei tāpiri, mā ō rātou wheako whakaako rātou e whakarite kia noho hei kaiwhakaako whai hua mā te whakangungu i a rātou ki te whakamahi i ngā tikanga whakaako e ahu mai ana i ngā taunakitanga.
I akohia ngā akoranga i te wā i whakatinanahia ai tēnei tauira. Tuatahi, he mea nui kia mōhio ki te uaua o te whanaungatanga whakawhitiwhiti i waenga i te MS4 me te SPI, nā te mea kāore ētahi takirua i te mārama ki te huarahi pai ki te mahi tahi. Ka aro pai ngā tūranga mārama, ngā pukapuka taipitopito me ngā awheawhe rōpū ki ēnei take. Tuarua, me whakarato whakangungu taipitopito hei whakapai ake i ngā mahi a te tīma. Ahakoa me whakangungu ngā huinga kaiako e rua ki te whakaako, me whakangungu hoki te SPI ki te mahi i ngā pūkenga whakamātautau kua mōhiotia kētia e te MS4. Tuatoru, me whakarite kia pai te whakamahere kia rite ki te kaupapa pukumahi o te MS4 me te whakarite kia tae mai te tīma katoa mō ia wāhanga aromatawai tinana. Tuawhā, e matapaetia ana ka tūtaki ngā kaupapa hou ki ētahi ātete mai i ngā kaiako me ngā kaiwhakahaere, me ngā tautohe kaha hei tautoko i te whai huatanga utu;
Hei whakarāpopototanga, ko te tauira whakaako tātaritanga tinana SPI-MS4 he tohu i tētahi auahatanga marautanga ahurei, whai hua hoki, e taea ai e ngā ākonga hauora te ako angitu i ngā pūkenga tinana mai i ngā tāngata ehara i te tākuta kua tino whakangungua. Nā te mea e whakamahi ana te nuinga o ngā kura hauora i te United States me te maha o ngā kura hauora o tāwāhi i te SP, ā, he maha ngā kura hauora he kaupapa ākonga-kaiako, he whānui ake te whakamahinga o tēnei tauira.
Kei a Tākuta Benjamin Blatt, MD, Kaiwhakahaere o te Pokapū Akoranga o GWU, te huinga raraunga mō tēnei rangahau. Kei roto i te rangahau ā mātou raraunga katoa.
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Wā tuku: Mei-11-2024