Cyran Elizabeth M, Albertson Gail, Schilling Lisa M, Lin Chen-Tan, Ware Lindsay, Steiner John F, Anderson Robert J
Internal Medicine Residency Program, Exempla Saint Joseph Hospital, Denver, CO 80218, USA.
J Gen Intern Med. 2006 May;21(5):435-9. doi: 10.1111/j.1525-1497.2006.00423.x.
To study the educational contributions of attending physicians in an internal medicine house staff ambulatory clinic.
Cross-sectional, self-administered survey.
University-affiliated general internal medicine practice.
PATIENTS/PARTICIPANTS: Internal medicine residents and attendings.
Attending and resident perceptions of whether attendings made contributions to teaching points, diagnosis (DX), therapy (RX), and health care maintenance (HCM) were assessed in 428 patient encounters. Resident assessments significantly exceeded attending self-assessments of contributions to teaching points (82% vs 74%, P=.001), DX (44% vs 34%, P=.001), RX (61% vs 55%, P=.02), and HCM (19% vs 15%, P=.04). Both residents and attendings perceived that contributions declined progressively with increasing resident year (P<.05). Primary care and categorical residents assessed attending contributions comparably. However, attendings perceived contributing more to RX and HCM for categorical residents than primary care (P<.05). Male and female residents assessed attending contributions comparably. However, attendings perceived contributing generally more to DX in male residents than female (P=.003). In 8% of encounters, either residents or attendings felt that patient evaluation by the attending was needed. In these encounters with personal patient evaluation by attendings, both residents and attendings felt that attendings made more contributions to DX (P=.001) and teaching points than in other encounters.
Attending physicians consistently underestimate their perceived contributions to house officer ambulatory teaching. Their personal patient evaluation increases assistance with DX and teaching points. Given perceived declining contributions by training year, attendings may need to identify other teaching strategies for interactions with senior residents.
研究内科住院医师门诊中主治医师的教育贡献。
横断面、自行填写的调查。
大学附属综合内科诊所。
患者/参与者：内科住院医师和主治医师。
在428次患者诊疗过程中，评估了住院医师和主治医师对于主治医师在教学要点、诊断（DX）、治疗（RX）和医疗保健维护（HCM）方面是否做出贡献的看法。住院医师的评估显著超过主治医师对教学要点贡献的自我评估（82%对74%，P = 0.001）、诊断（44%对34%，P = 0.001）、治疗（61%对55%，P = 0.02）和医疗保健维护（19%对15%，P = 0.04）。住院医师和主治医师都认为，随着住院医师年资增加，贡献逐渐减少（P < 0.05）。初级保健和专科住院医师对主治医师贡献的评估相当。然而，主治医师认为对专科住院医师在治疗和医疗保健维护方面的贡献比对初级保健住院医师更多（P < 0.05）。男性和女性住院医师对主治医师贡献的评估相当。然而，主治医师认为对男性住院医师在诊断方面的贡献总体上比对女性更多（P = 0.003）。在8%的诊疗过程中，住院医师或主治医师认为需要主治医师进行患者评估。在这些由主治医师进行个人患者评估的诊疗过程中，住院医师和主治医师都认为主治医师在诊断（P = 0.001）和教学要点方面的贡献比其他诊疗过程更多。
主治医师一直低估他们对住院医师门诊教学的贡献。他们的个人患者评估增加了对诊断和教学要点的帮助。鉴于随着培训年资贡献似乎在下降，主治医师可能需要确定与高年级住院医师互动的其他教学策略。
