Anzarut Alexander, Singh Prabhjyot, Cook Geoff, Domes Trustin, Olson Jarret
Edmonton, Alberta, Canada From the Division of Plastic and Reconstructive Surgery, Department of Public Health Sciences, EPICORE Center, and Faculty of Medicine and Dentistry, University of Alberta.
Plast Reconstr Surg. 2007 May;119(6):1933-1939. doi: 10.1097/01.prs.0000259209.56609.83.
Continuing medical education for referring physicians is an essential part of raising the profile of plastic surgery and improving patient care. The authors conducted a prospective cohort study to assess the educational needs of emergency and primary care physicians who refer patients to the on-call plastic surgeon.
The following information was collected for telephone referrals from emergency and primary care physicians over a 1-year period: date, location of referral center, population of referral center, distance between referral center and tertiary care hospital, patient age, presenting problem, anatomical location of the problem, and treatment plan proposed by the plastic surgeon. In addition, the 50 physicians who most frequently referred patients were surveyed to identify which topics they perceived to be of the highest educational utility and which were frequently encountered.
There were a total of 1077 referrals to on-call plastic surgeons, mostly for trauma (83 percent) and injuries involved primarily the upper extremity (65 percent) or head and neck regions (26 percent). Five percent or more of all referrals involved mandible, phalangeal, metacarpal, or zygomatico-orbital complex fractures, minor burns, flexor tendon injuries, single digits requiring revision of an amputation, and extensor tendon injuries. Referring physicians reported that the topics of most educational utility were management of hand infections, minor burns, nasal fractures, boxer's fractures, complex facial lacerations, frostbite, metacarpal fractures, and scaphoid fractures.
To have the greatest potential affect on changing physicians' behavior and improving patient care, continuing medical education should focus on traumatic injuries to the upper extremity and head and neck regions. A prioritized list of topics should include management of minor burns, hand fractures, hand infections, nasal infections, and complex facial lacerations.
为转诊医生提供继续医学教育是提升整形外科知名度和改善患者护理的重要组成部分。作者开展了一项前瞻性队列研究，以评估将患者转诊至随叫随到的整形外科医生的急诊和初级保健医生的教育需求。
收集了1年期间急诊和初级保健医生通过电话转诊的以下信息：日期、转诊中心位置、转诊中心人口、转诊中心与三级医院之间的距离、患者年龄、就诊问题、问题的解剖位置以及整形外科医生提出的治疗方案。此外，还对转诊患者最频繁的50名医生进行了调查，以确定他们认为哪些主题具有最高的教育价值以及哪些是经常遇到的。
总共向随叫随到的整形外科医生转诊了1077例患者，大多数是因创伤（83%），受伤主要涉及上肢（65%）或头颈部区域（26%）。所有转诊病例中有5%或更多涉及下颌骨、指骨、掌骨或颧眶复合体骨折、轻度烧伤、屈肌腱损伤、需要截肢修复的单指以及伸肌腱损伤。转诊医生报告说，最具教育价值的主题是手部感染的管理、轻度烧伤、鼻骨骨折、拳击手骨折、复杂面部裂伤、冻伤、掌骨骨折和舟骨骨折。
为了对改变医生的行为和改善患者护理产生最大的潜在影响，继续医学教育应侧重于上肢以及头颈部区域的创伤性损伤。优先主题列表应包括轻度烧伤的管理、手部骨折、手部感染、鼻感染和复杂面部裂伤。
