Quinn Doris C, Bingham John W, Shourbaji Nader A, Jarquin-Valdivia Adrian A
Division of Medical Education and Administration, Vanderbilt University Medical Center, Nashville, TN, USA.
Med Teach. 2007 Sep;29(7):660-5. doi: 10.1080/01421590701593971.
The Institute of Medicine identified six Aims for Improvement to drive the transformation of healthcare. Simultaneously, the Accreditation Council for Graduate Medical Education issued six competencies as part of the training of residents. American Board of Medical Specialties has also endorsed these competencies for maintenance of certification. Many training programs have struggled with the implementation of these competencies.
This article describes two applications of The Healthcare Matrix which teaches the Core Competencies while leveraging the IOM? Aims for Improvement? as a means of anchoring the competencies in care of patients.
Third year medical students used the Matrix to identify the facilitators and barriers to quality of care. Second year internal medicine residents also use the Matrix during their ambulatory rotation.
Learners gained new insights into patient issues by using the Matrix and analysis of multiple matrices identified ?themes? of what needed to be improved. When taught the tools and methods of quality improvement, medical students and residents learn to lead the improvement of care.
The Matrix has changed the way conferences are held because they bring all the competencies to bear on the discussion. There is less of a focus on the ?individual? and more on the systems in need improvement.
美国医学研究所确定了六项改进目标以推动医疗保健的变革。同时，毕业后医学教育认证委员会发布了六项能力要求，作为住院医师培训的一部分。美国医学专业委员会也认可这些能力要求以维持认证。许多培训项目在实施这些能力要求方面遇到了困难。
本文描述了《医疗保健矩阵》的两种应用，该矩阵在利用医学研究所的改进目标的同时教授核心能力要求，以此作为将这些能力要求锚定在患者护理中的一种方式。
三年级医学生使用该矩阵来确定护理质量的促进因素和障碍。二年级内科住院医师在门诊轮转期间也使用该矩阵。
学习者通过使用该矩阵对患者问题有了新的见解，对多个矩阵的分析确定了需要改进的“主题”。当教授质量改进的工具和方法时，医学生和住院医师学会引领护理改进。
该矩阵改变了会议召开的方式，因为它们使所有能力要求都能应用于讨论中。较少关注“个人”，而更多关注需要改进的系统。
