Reines H David, Robinson Linda, Duggan Mary, O'brien Beverly M, Aulenbach Kristen
Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
Am J Surg. 2006 Jul;192(1):119-24. doi: 10.1016/j.amjsurg.2006.01.047.
Meeting the educational needs and requirements of surgical resident physicians while achieving optimal patient care is a challenge for program directors. Midlevel practitioners (MLPs) were employed by a large community teaching hospital to augment the surgical teaching service, to improve continuity of patient care, and to provide resident physicians with greater flexibility to participate in classroom, operative, and clinical educational experiences. The MLPs were carefully integrated into the surgical program by creating the necessary buy-in, developing positive relationships, decreasing resistance, and reinforcing acceptance when demonstrated. MLPs function at the level of junior resident physicians and are active participants in the teaching and evaluation process. Structurally, MLPs receive their assignments from and report to the chief resident physician, but are ultimately responsible to the program director. Instituting the program required providing financial justification to administration and flexibility in meeting the diverse needs of the four teams. As a result, surgical resident physicians have been sufficiently freed from service activities to be able to capitalize on learning activities that range from surgeries to conferences. MLPs can be integrated into a surgical teaching program and become a positive force in the education of resident physicians.
对于项目主任而言，在满足外科住院医师的教育需求和要求的同时实现最佳患者护理是一项挑战。一家大型社区教学医院聘请中级从业者（MLP）来加强外科教学服务，改善患者护理的连续性，并为住院医师提供更大的灵活性，使其能够参与课堂、手术和临床教育体验。通过建立必要的支持、发展积极的关系、减少阻力并在表现出接受时加强认可，MLP被精心融入到外科项目中。MLP发挥初级住院医师的作用，是教学和评估过程中的积极参与者。在结构上，MLP从总住院医师那里接受任务并向其汇报，但最终对项目主任负责。设立该项目需要向管理层提供财务理由，并在满足四个团队的不同需求方面具有灵活性。结果，外科住院医师已从服务活动中充分解脱出来，能够利用从手术到会议等各种学习活动。MLP可以融入外科教学项目，并成为住院医师教育中的积极力量。
