Frey Keith, Edwards Frederick, Altman Kathryn, Spahr Nancy, Gorman R Scott
Department of Family Medicine, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA.
Med Educ. 2003 Sep;37(9):786-9. doi: 10.1046/j.1365-2923.2003.01598.x.
The 'Collaborative Care' curriculum is a 12-month senior resident class project in which one evidence-based clinical guideline is designed, implemented and evaluated in our residency practice. This curriculum specifically addresses three of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies: Practice-Based Learning and Improvement, Interpersonal and Communication Skills and System-Based Practices. Additionally, the project enhances the quality of patient care within the model family practice centre in a family practice residency.
During the project, the third-year residency class selects the disease, develops the clinical guideline, leads its implementation and guides the evaluation process. Select faculty members serve as mentors and coach the resident class through each phase of the project. Specific educational objectives are developed for each content area: evidence-based medicine, clinical guideline development, continuous quality improvement and team leadership. A series of seminars are presented during the project year to provide 'just-in-time' learning for the key content and skills required for each step in the project. By working together to develop the practice guideline, then working with nurses and allied health staff to implement the guideline and review its effectiveness, the resident team gains competence in the areas of practice-based learning and improvement, interpersonal and communication skills and system-based practices.
The self-reported level of resident confidence in skill acquisition for each content area was measured for each resident at the time of graduation from the residency programme. Results from the first 2 years of this curriculum are reported (resident n = 12), and demonstrate a high level of physician confidence in the skills addressed and their utility for future practice.
The senior resident seminar and team project model reported here creates learning experiences that appear to address at least three of the ACGME general competency expectations: practice-based learning and improvement, interpersonal communication skills, and systems-based practice. From the initial resident feedback, this educational model seems to establish a high level of physician confidence in the skills addressed and their utility for future practice.
“协作护理”课程是一项为期12个月的高级住院医师班级项目，在我们的住院医师培训实践中设计、实施并评估一项循证临床指南。该课程专门针对毕业后医学教育认证委员会（ACGME）六项核心能力中的三项：基于实践的学习与改进、人际沟通技能和基于系统的实践。此外，该项目提高了家庭医学住院医师培训中示范家庭医疗中心的患者护理质量。
在项目期间，三年级住院医师班级选择疾病、制定临床指南、领导其实施并指导评估过程。选定的教员担任导师，并在项目的每个阶段指导住院医师班级。为每个内容领域制定了具体的教育目标：循证医学、临床指南制定、持续质量改进和团队领导。在项目年度内举办了一系列研讨会，为项目每个步骤所需的关键内容和技能提供“即时”学习。通过共同制定实践指南，然后与护士和专职医疗人员合作实施指南并评估其有效性，住院医师团队在基于实践的学习与改进、人际沟通技能和基于系统的实践等领域获得了能力。
在住院医师培训项目毕业时，对每位住院医师在每个内容领域技能获取方面的自我报告信心水平进行了测量。报告了该课程前两年的结果（住院医师n = 12），结果显示医生对所涉及技能及其在未来实践中的实用性有很高的信心。
本文报道的高级住院医师研讨会和团队项目模式创造了似乎满足ACGME至少三项总体能力期望的学习体验：基于实践的学习与改进、人际沟通技能和基于系统的实践。从最初的住院医师反馈来看，这种教育模式似乎使医生对所涉及技能及其在未来实践中的实用性建立了高度信心。
