Peters Antoinette S, Kimura Joe, Ladden Maryjoan D, March Elizabeth, Moore Gordon T
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA.
J Gen Intern Med. 2008 Jul;23(7):931-6. doi: 10.1007/s11606-008-0517-0.
When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many.
To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI.
ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before-after cross-comparison of ACT residents and their peers.
Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005. RESULTS AND MAIN MEASUREMENTS: All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program's principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents' gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls' (-1.9, -8.0), but changes in attitudes were not significantly different. Faculty preceptors' knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale).
ACT increased residents' knowledge and self-assessment of their own competency and raised faculty's assessment of the importance of residents' learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.
1999年系统-based实践（SBP）和基于实践的学习与改进（PBLI）被规定为住院医师的能力要求时，对许多人来说还是新概念。
描述并评估一个为期4周的临床选修课（今日实现能力——ACT），以教授住院医师SBP和PBLI。
ACT包括一个为期四周的主动学习课程和后续教学经验，由网络材料指导和支持。课程包括阅读材料、预定活动、包括改进项目在内的工作成果，以及与非专家指导教师的每周会议。评估采用ACT住院医师与其同龄人前后交叉比较的方式。
2003年至2005年间，美国18个内科住院医师培训项目的78名住院医师和42名教员参与其中。结果与主要测量指标：所有住院医师和教员指导教师都参加了知识测试、态度调查以及对与SBP/PBLI相关的15项任务的能力自我评估。所有指标都被标准化为100分制。每个项目的主要研究者（PI）确定了ACT在促进住院医师学习方面最有效和最无效的方面。ACT住院医师在知识（100分制上得4.4分）和自我评估能力（11.3分）方面的提升大于对照组（-1.9分，-8.0分），但态度变化无显著差异。教员指导教师的知识得分没有变化，但他们的态度变得更积极（15.8分）。PI发现现成可用的课程很有效（10分制上评分为8.5分）。
ACT提高了住院医师的知识水平和对自身能力的自我评估，并提高了教员对住院医师学习SBP/PBLI重要性的评估。住院医师学习SBP/PBLI不需要教员具备内容专业知识。
