Kelly Sean P, Shapiro Nathan, Woodruff Michael, Corrigan Kelly, Sanchez Leon D, Wolfe Richard E
Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Acad Emerg Med. 2007 Jun;14(6):526-31. doi: 10.1197/j.aem.2007.01.024. Epub 2007 May 4.
Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching.
To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED).
This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten-point scales. A linear mixed-effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies.
No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (beta estimate, 0.024; p = 0.55), attending physicians' workload perception (beta estimate, -0.05; p = 0.28), patient volume in patients per hour (beta estimate, -0.010; p = 0.36), and shift type (beta estimate, -0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (beta estimate, 0.12; p = 0.005), clinical teaching skills (beta estimate, 0.36; p < 0.001), willingness to teach (beta estimate, 0.25; p < 0.001), and interpersonal skills (beta estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (beta estimate, 0.007; p = 0.35).
Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were.
学术型急诊医生担心临床工作量增加和过度拥挤会对临床教学产生不利影响。
评估临床工作量和主治医生的教学特点对急诊科临床教学的影响。
这是一项前瞻性观察研究，使用学习者满意度评估工具来评估床边教学。在有研究助理的日子里，对所有急诊科住院医师和主治医生进行询问。在九个月内共进行了335次住院医师调查（回复率89%）。临床工作量通过感知和患者数量来衡量。教学质量和特点采用十分制评分。使用线性混合效应模型在控制个体主治医生的教学能力和住院医师的评分倾向的同时，获得临床工作量和教学属性对教学分数的调整影响估计值。
没有临床工作量参数对教学分数有显著影响：住院医师的工作量感知（β估计值，0.024；p = 0.55）、主治医生的工作量感知（β估计值，-0.05；p = 0.28）、每小时患者数量（β估计值，-0.010；p = 0.36）和轮班类型（β估计值，-0.19；p = 0.28）。个体主治医生的影响显著（p < 0.001），且在每种情况下都进行了调整。在另一个模型中，主治医生建立起的学习环境（β估计值，0.12；p = 0.005）、临床教学技能（β估计值，0.36；p < 0.001）、教学意愿（β估计值，0.25；p < 0.001）和人际技能（β估计值，0.19；p < 0.001）影响教学分数，但主治医生的教学可及性没有显著影响（β估计值，0.007；p = 0.35）。
临床工作量和主治医生的教学可及性对教学分数影响很小。主治医生的临床教学技能、教学意愿、人际技能和建立起的学习环境是总体分数的重要决定因素。熟练的带教老师得分更高，无论他们有多忙。
