目的:临床设置越来越注重满足患者的社会需求,因此,医学教育必须为未来的临床医生做好准备。批判意识,将健康置于更广泛的社会中的意识,历史,和文化背景,可以帮助塑造学生对病人社会需求的理解。我们的论文探讨了体验式学习如何通过参与社会护理干预来加深学生的批判意识,或他们对使患者难以满足其基本需求的系统和结构的理解。
方法:我们对所有24名倡导干预的学生进行了一对一的半结构化访谈。在24名倡导者中,75%(n=18)是一年级医学生,17%(n=4)是公共卫生学生,8%(n=2)是社会工作专业的学生。面试有音频记录,逐字转录,并使用框架分析法进行了分析。
结果:我们确定了以批判意识为基础的主题,包括个人(假设和偏见),人际关系(沟通和关系),和结构(组织和权力)因素。在这些类别中,倡导者表达了对个人偏见(个人)的更深层次的自我意识,人际沟通对与照顾者(人际)建立信任的重要性,以及确定影响健康的结构因素,如住房条件(结构)。倡导者强调了体验式学习的重要性,以帮助他们了解健康的社会决定因素。通过见证多个患者经历社会需求,倡导者看到了社会需求的级联效应,难以满足基本需求的结构,以及对健康和保健行为的影响。
结论:参与干预的学生表现出批判性意识的发展。虽然有限,我们的研究结果表明,当学生围绕社会需求与患者接触时,学生可以更好地理解患者生活的更广泛的社会背景。通过社会护理干预进行的体验式学习可能有可能影响关键意识的发展并塑造未来临床医生的实践。
OBJECTIVE: Clinical settings are increasingly focused on addressing patients\' social needs, thus medical education must prepare future clinicians for this task. Critical consciousness, an awareness that puts health within a broader social, historical, and cultural context, could help shape students\' understanding of patient social needs. Our paper explores how experiential learning through participation in a social care intervention deepened students\' critical consciousness, or their understanding of the systems and structures that make it difficult for patients to meet their basic needs.
METHODS: We conducted one-on-one semistructured interviews with all 24 students who served as advocates for the intervention. Of the 24 advocates, 75% (n = 18) were first-year medical students, 17% (n = 4) were public health students, and 8% (n = 2) were social work students. Interviews were audiorecorded, transcribed verbatim, and analyzed using framework analysis.
RESULTS: We identified themes informed by critical consciousness, including individual (assumptions and biases), interpersonal (communication and relationship), and structural (organization and power) factors. Within these categories, advocates expressed deeper self-awareness of personal biases (individual), the importance of interpersonal communication to build trust with caregivers (interpersonal), and the identification of the structural factors that influence health, such as housing conditions (structural). The advocates highlighted the importance of experiential learning to help them understand social determinants of health. By witnessing multiple patients experiencing social needs, advocates saw the cascading effects of social needs, the structures that make it difficult to meet basic needs, and the effect on health and healthcare behavior.
CONCLUSIONS: Students engaged in the intervention demonstrated the development of critical consciousness. Although limited, our findings suggest that when students engage with patients around social needs, students can better understand the broader social context of patients\' lives. Experiential learning through social care interventions may have the potential to influence critical consciousness development and shape the practice of future clinicians.