Siri Jean, Reed Alan I, Flynn Timothy C, Silver Michele, Behrns Kevin E
Department of Surgery, University of Florida, Gainesville, Florida 32610, USA.
J Surg Educ. 2007 Nov-Dec;64(6):328-32. doi: 10.1016/j.jsurg.2007.05.002.
To design and implement a multidisciplinary systems-based practice learning experience that is focused on improving and standardizing the preoperative quality of care for general surgical patients.
Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V), each led by 1 chief resident, were assigned a quality parameter, performed an evidence-based current literature review, and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, we presented our findings at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Department of Anesthesia, the Department of Medicine, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings in order to determine how standardization of preoperative care would alter anesthetic and nursing care, and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment on the teaching experience, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale.
Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation given each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care as well as the associated need for appropriate medical knowledge, communication, and professionalism. The derivation of treatment protocols included an opportunity to incorporate several competencies across multiple disciplines. The residents evaluated 5 questions and deemed the educational exercise an effective model to enrich surgical resident education while simultaneously improving patient care. The residents also strongly agreed that they would participate in similar projects in the future as well as recommend this educational exercise to other residents. A finalized preoperative order set was created and distributed to all residents for use in the preoperative care of general surgery patients.
Our multidisciplinary systems-based practice learning experience focused on improving and standardizing the preoperative quality of care for patients, and general surgery residents were pivotal participants in that process. This exercise had a positive impact on our general surgery residency education program and proved to be a valuable model of systems-based practice competency.
设计并实施一项基于多学科系统的实践学习体验，重点在于改善和规范普通外科患者的术前护理质量。
术前护理的四个参数被指定为质量评估变量，包括肠道准备、围手术期β受体阻滞剂的使用、预防性抗生素的使用以及深静脉血栓形成的预防。四组普通外科住院医师（PGY I - V），每组由一名总住院医师带领，被分配一个质量参数，进行循证的当前文献综述，并根据现有证据水平和建议制定标准化管理方法。由于术前准备包括麻醉护理和手术室准备，我们以多学科形式在外科大查房时展示了我们的研究结果，包括每个住院医师小组、麻醉科、内科和护理部的汇报。多学科质量保证会议的目的是展示循证文献研究结果，以确定术前护理的标准化将如何改变麻醉和护理，以及获取关于管理方案的反馈。为了确定这种基于综合系统实践质量评估模式对教学体验的教育影响，就该教育场所的价值对住院医师进行了询问，并根据李克特量表对回答进行评分。
住院医师参与度很高。住院医师通过进行文献综述以及评估针对每个参数的最佳术前准备获得了有价值的信息。此外，将他们的研究结果整合到包括麻醉和护理的基于系统的实践中，让他们认识到护理的复杂性以及对适当医学知识、沟通和专业素养的相关需求。治疗方案的推导包括了整合多个学科多种能力的机会。住院医师对5个问题进行了评估，并认为该教育活动是丰富外科住院医师教育同时改善患者护理的有效模式。住院医师还强烈同意他们未来会参与类似项目，并会向其他住院医师推荐这个教育活动。最终创建了一份术前医嘱集并分发给所有住院医师，用于普通外科患者的术前护理。
我们基于多学科系统的实践学习体验重点在于改善和规范患者的术前护理质量，普通外科住院医师是这一过程的关键参与者。这项活动对我们的普通外科住院医师培训教育项目产生了积极影响，并被证明是基于系统实践能力的宝贵模式。
