Characteristics of the effective tutor in pbl: a literature review

ABSTRACT In general, students have few opportunities to address their emotions under the guidance of an experienced physician, which can undermine their self-confidence to deal with real patients in stressful situations. Emotional detachment and cynicism are defense mechanisms, which can emerge as a consequence. The consolidation of a professional identity committed to patients' interests can become a challenge when medical students are not comfortable in their role as caregivers. In general, we consider that the undergraduate medical curriculum has been insufficient in providing appropriate environments for students to reflect on professional identity formation and on the future challenges of their profession. Objective: To develop an in-depth debriefing to address students' emotions and professional identity formation in the context of a simulation activity with simulated patients at a medical school in Brazil. Methods: The authors conducted a simulated medical consultation activity using standardized patients (SPs) with an in-depth debriefing based on the feelings of the patient and the student. During each encounter the formation and consolidation of professional identity was discussed. Fourth- and sixth-year medical students (n=551) participated and answered a questionnaire about the activity and the learning outcome. Results: The students felt comfortable during the activity, due to “openness to dialogue”, “proximity with colleagues and teachers” and the “judgment-free environment”. More than 90% reported that what they had learned would be useful in their professional and personal lives, providing a greater “understanding of emotions”, “empathy”, “ability to listen” and “ability to deal with conflicts”. More than half of them were motivated to study, especially “doctor-patient relationship”, “treatment”, “common diseases” and “medicine in general”. Students considered the activity important for retrieving the initial reasons that had led them to embarking on the medical profession in the first place. Conclusions: Reflecting on disease and its impact on patients' daily life may motivate learning in medicine, allowing for the recovery of the personal and social meaning of its practice. In-depth debriefing was important to nurture professional identity committed to empathy and patients' interests. Activities planned to discuss the influence and importance of emotions in medical practice can help students to reconcile personal and professional identities.摘要 总体而言，医学生鲜有机会在资深医师的指导下梳理自身情绪，这可能会削弱他们在高压情境下应对真实患者时的自信心，进而催生情绪抽离与冷漠这两种心理防御机制。当医学生无法以照护者的身份自如履职时，构建以患者利益为核心的职业认同便会成为一项挑战。总体而言，当前的本科医学课程在为学生提供反思职业认同塑造及行业未来挑战的适宜环境方面仍存在不足。 研究目标：针对巴西某医学院开展的模拟患者诊疗实训活动，开发一套可用于梳理学生情绪、助力其职业认同塑造的深度复盘方案。 研究方法：本研究采用标准化患者（standardized patients, SPs）开展模拟诊疗活动，并基于患者与学生的切身感受实施深度复盘。每场实训期间，均会围绕职业认同的形成与巩固展开讨论。本次研究共招募551名四年级与六年级医学生参与，要求其填写关于本次实训及学习成果的调查问卷。 研究结果：参与学生均表示本次实训氛围轻松自在，这得益于"开放的对话氛围""与同学及教师的亲近感"以及"无评判的宽松环境"。超过90%的学生表示，本次实训所学内容将对其职业与个人生活均有所助益，能够帮助他们更好地"理解情绪""培养共情能力""提升倾听技巧"以及"掌握冲突应对能力"。超过半数的学生因此激发了学习动力，尤其在"医患关系""诊疗方案""常见疾病"及"全科医学"领域。学生们普遍认为，本次实训有助于他们重拾最初选择从医的初心。 研究结论：反思疾病及其对患者日常生活的影响，可激发医学生的学习热情，帮助他们重拾医学实践的个人与社会意义。深度复盘活动对于培育以共情与患者利益为核心的职业认同具有重要意义。旨在探讨情绪在医学实践中的影响与价值的实训活动，能够帮助学生协调个人身份与职业身份之间的关系。