PDF(Pubmed)
Abstract：
BACKGROUND: Geopolitical and socioeconomic challenges limit faculty development and clinical teaching in Palestine and many other developing countries. The first, and still only, Family Medicine (FM) residency program is a four-year program based out of An-Najah University in the West Bank. Training in primary care clinics occurs in the final two years and there are many challenges to adequate supervision in the clinical setting that were exacerbated during the pandemic. To improve the readiness for practice skills of 13 Palestinian FM residents a three-month tutorial program was organized in 2020. A nongovernmental organization (NGO) that has worked to support Family Medicine development in the region engaged experienced British and American General Practitioners trained as tutors to offer online tutorials. We examined the program as a case study to understand the factors that facilitated or impaired a positive virtual learning environment in a middle/low income country.
METHODS: The tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment.
RESULTS: Themes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive.
CONCLUSIONS: Transnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.
METHODS: The tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment.
RESULTS: Themes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive.
CONCLUSIONS: Transnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.
摘要：
背景：地缘政治和社会经济挑战限制了巴勒斯坦和许多其他发展中国家的教师发展和临床教学。第一,仍然只有，家庭医学（FM）居住计划是一项为期四年的计划，该计划来自西岸的An-Najah大学。初级保健诊所的培训在最后两年进行，在大流行期间，临床环境中的充分监督面临许多挑战。为了提高13名巴勒斯坦FM居民的实践技能的准备程度，在2020年组织了为期三个月的教程计划。一个致力于支持该地区家庭医学发展的非政府组织（NGO）聘请了经验丰富的英国和美国全科医生作为导师提供在线教程。我们将该计划作为案例研究进行了研究，以了解在中等/低收入国家促进或损害积极的虚拟学习环境的因素。
方法：导师和居民被分成几组，几乎在2020年6月至9月之间会面。在计划期间收集的评估和会议报告，网上聊天的文本，并收集了两年后对在线调查的回应。使用主题分析技术，我们评估了当时和两年后居民的价值，并确定了促进或损害积极虚拟学习环境的因素。
结果：知识主题，技能,态度，文化脱节,和教程物流应运而生。导师配对最稳定的群体，包括一名熟悉上下文的阿拉伯语使用者，是最订婚的。全女性小组组成了一个聊天小组，在临床实践中分享实时病例问题，并专注于技能（例如进行全面的药物审查）和态度（例如开放分享和讨论不确定性）。其他群体的凝聚力较低。
结论：专注于临床思维和决策技能的跨国教程在教程对稳定时最成功，提供熟悉的语言和解决文化差异。内在因素，如缺乏参与动力，外在因素，如不稳定的互联网和滚动电切，而使新技能应用具有挑战性的临床结构更难以解决，但必须加以考虑。
方法：导师和居民被分成几组，几乎在2020年6月至9月之间会面。在计划期间收集的评估和会议报告，网上聊天的文本，并收集了两年后对在线调查的回应。使用主题分析技术，我们评估了当时和两年后居民的价值，并确定了促进或损害积极虚拟学习环境的因素。
结果：知识主题，技能,态度，文化脱节,和教程物流应运而生。导师配对最稳定的群体，包括一名熟悉上下文的阿拉伯语使用者，是最订婚的。全女性小组组成了一个聊天小组，在临床实践中分享实时病例问题，并专注于技能（例如进行全面的药物审查）和态度（例如开放分享和讨论不确定性）。其他群体的凝聚力较低。
结论：专注于临床思维和决策技能的跨国教程在教程对稳定时最成功，提供熟悉的语言和解决文化差异。内在因素，如缺乏参与动力，外在因素，如不稳定的互联网和滚动电切，而使新技能应用具有挑战性的临床结构更难以解决，但必须加以考虑。
