美国的神经科住院医师是否被传授了防御性医疗知识？
Are neurology residents in the United States being taught defensive medicine?
作者信息
Brilla Roland, Evers Stefan, Deutschländer Angela, Wartenberg Katja Elfriede
机构信息
School of Public Health at the University of Illinois at Chicago and Department of Neurology, Aurora Sheboygan Clinic, 2414 Kohler Memorial Drive, Sheboygan, WI 53081, USA.
出版信息
Clin Neurol Neurosurg. 2006 Jun;108(4):374-7. doi: 10.1016/j.clineuro.2005.05.013. Epub 2005 Jul 22.
OBJECTIVE
To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes.
METHODS
Neurology residents in the US (n=25) and, as a control group, Neurology residents training in Germany (n=42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.
RESULTS
Residents in both countries indicated that litigation is an "important problem", although US residents stated this significantly more often (p<0.001). Initiation of tests motivated mainly by fear of litigation (p=0.004) and explicit teaching of defensive strategies by teaching physicians (p<0.02) were reported more often by US residents.
CONCLUSION
Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.
目的
研究在住院医师培训期间是否以及如何传达对诉讼的恐惧和防御性医疗行为，并评估这是否会影响住院医师的态度。
方法
美国的神经科住院医师（n = 25）以及作为对照组的在德国接受培训的神经科住院医师（n = 42）被要求对关于诉讼、防御策略以及带教医师提及这些问题的频率等多个项目进行评分。使用非参数检验进行统计分析。
结果
两国的住院医师均表示诉讼是一个“重要问题”，不过美国住院医师提及的频率明显更高（p < 0.001）。美国住院医师报告称，因担心诉讼而进行检查的情况（p = 0.004）以及带教医师明确传授防御策略的情况（p < 0.02）更为常见。
结论
美国和德国的神经科住院医师都察觉到了诉讼威胁，但德国的程度明显较低。这种差异可能至少部分源于美国培训项目中防御策略传授更为频繁。
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