Evans Dason E, Wood Diana F, Roberts C Michael
Clinical, Communication and Learning Skills Unit, Bart's and the London, Queen Mary's School of Medicine and Dentistry, St Bartholomew's Hospital, London, UK.
Med Educ. 2004 Sep;38(9):998-1001. doi: 10.1111/j.1365-2929.2004.01908.x.
Recent studies raise concerns over the preparedness of newly qualified doctors for the role of the pre-registration house officer (PRHO). This study aimed to assess self-perception of preparedness, objective assessment of core clinical skills and the effect of an extended clinical induction programme prior to commencing full duties.
A group of 26 newly qualified doctors from 1 district general hospital underwent an extended 5-day, ward-based induction programme. The participants completed questionnaires on their own perceptions of their preparedness for PRHO duties and underwent an objective structured clinical examination (OSCE) of 4 core clinical skills prior to induction, on completion of induction and 1 month into working life.
At the outset PRHOs had low perceptions of their own capabilities in all clinical scenarios and skills. Most perceptions improved after induction, although in 2 clinical areas they felt even less confident. One month into post there were significant improvements in all areas. Only 1 PRHO passed all 4 clinical skills assessments at the pre-induction assessment. Seven (26%) failed on 1 or more skills at the post-induction assessment. However, all participants were deemed competent in all skills at the 1-month assessment.
Newly qualified doctors do not feel prepared for PRHO duties and objectively are not competent in basic clinical skills. An extended induction improves preparedness in some but not all clinical areas and improves performance of objectively assessed clinical skills.
近期研究引发了对于新获得资格的医生担任注册前住院医师（PRHO）角色的准备情况的担忧。本研究旨在评估对准备情况的自我认知、核心临床技能的客观评估以及在开始全职工作前进行的延长临床入职培训计划的效果。
一组来自1家地区综合医院的26名新获得资格的医生参加了为期5天的延长的基于病房的入职培训计划。参与者完成了关于他们对PRHO职责准备情况的自我认知的问卷，并在入职培训前、培训结束时和工作1个月后接受了4项核心临床技能的客观结构化临床考试（OSCE）。
一开始，PRHO对自己在所有临床场景和技能方面的能力认知较低。大多数认知在培训后有所改善，尽管在2个临床领域他们感觉信心更低。工作1个月后，所有领域都有显著改善。在入职培训前的评估中，只有1名PRHO通过了所有4项临床技能评估。在培训后的评估中，7名（26%）在1项或多项技能上未通过。然而，在1个月的评估中，所有参与者在所有技能方面都被认为是胜任的。
新获得资格的医生觉得自己没有为PRHO职责做好准备，并且客观上在基本临床技能方面不胜任。延长的入职培训在一些但不是所有临床领域提高了准备情况，并提高了客观评估的临床技能的表现。
