Zhu Jia Ni, Weiland Tracey J, Taylor David M, Dent Andrew W
Emergency Practice Innovation Centre, St. Vincent's Hospital, Melbourne, VIC.
Med J Aust. 2008 May 5;188(9):514-9. doi: 10.5694/j.1326-5377.2008.tb01765.x.
To describe how intern time is spent, and the frequency of activities performed by interns during emergency department (ED) rotations.
Prospective observational study of 42 ED interns from three Melbourne city teaching hospitals during 5 months in 2006. Direct observations were made by a single researcher for 390.8 hours, sampling all days of the week and all hours of the day.
Proportion of time spent on tasks and number of procedures performed or observed by interns.
Direct patient-related tasks accounted for 86.6% of total intern time, including 43.9% spent on liaising and documentation, 17.5% obtaining patient histories, 9.3% on physical examinations, 5.6% on procedures, 4.8% ordering or interpreting investigations, 3.0% on handover and 4.9% on other clinical activities. Intern time spent on non-clinical activities included 4.2% on breaks, 3.7% on downtime, 1.7% on education, and 1.3% on teaching others. Adjusted for an 8-week term, the ED intern would take 253 patient histories, consult more senior ED staff on 683 occasions, perform 237 intravenous cannulations/phlebotomies, 39 arterial punctures, 12 wound repairs and apply 16 plasters. They would perform chest compressions under supervision on seven occasions, observe defibrillation twice and intubation once, but may not see a thoracostomy.
The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience.
描述实习医生在急诊科轮转期间的时间分配情况以及所执行活动的频率。
2006年5个月期间，对墨尔本市区三家教学医院的42名急诊科实习医生进行前瞻性观察研究。由一名研究人员进行直接观察，时长390.8小时，涵盖一周中的所有日子和一天中的所有时段。
实习医生用于各项任务的时间比例以及执行或观察到的操作数量。
与患者直接相关的任务占实习医生总时间的86.6%，其中43.9%用于沟通联络和文档记录，17.5%用于获取患者病史，9.3%用于体格检查，5.6%用于操作，4.8%用于开具或解读检查，3.0%用于交接班，4.9%用于其他临床活动。实习医生用于非临床活动的时间包括4.2%用于休息，3.7%用于停工时间，1.7%用于教育，1.3%用于教导他人。按8周的实习期计算，急诊科实习医生将获取253份患者病史，向急诊科资深 staff 咨询683次，进行237次静脉穿刺/静脉切开术采血，39次动脉穿刺，12次伤口缝合，以及使用16次敷料。他们将在监督下进行7次胸外按压，观察2次除颤和1次插管，但可能看不到胸廓造口术。
急诊科使实习医生接触到广泛多样的活动。随着实习医生数量预期增加，可能会出现急诊医学经验被稀释的情况，且监督需求可能会增加。用其他轮转替代急诊科轮转可能会使实习医生失去宝贵的学习经历。
