Morrison Laura J, Headrick Linda A
Department of Medicine, Section of Geriatrics, Baylor College of Medicine, Houston, USA.
Jt Comm J Qual Patient Saf. 2008 Aug;34(8):453-9. doi: 10.1016/s1553-7250(08)34056-2.
The Accreditation Council for Graduate Medical Education has endorsed practice-based learning and improvement (PBLI) as a core competency for residents. Health professions educators have sought since the early 1990s to incorporate quality improvement principles, methods, and skills into training programs. A literature review indicates that questions remain regarding how to best train physicians to lead the improvement of patient care. The efficacy of two PBLI educational interventions was examined by comparing the performance of participating residents with that of controls.
Personal improvement projects (PIPs) and a workshop were implemented to teach PBLI to internal medicine residents. Residents in an ambulatory block rotation were required to complete a PIP. All residents were invited to attend the workshop. Those participating in neither served as controls.
An instrument was used to assess applied improvement knowledge for PIP participants at project completion and all residents six to eight months later. Analysis of variance showed no difference between the performance of PIP participants at project completion and PIP participants and controls six to eight months later. A second analysis compared six- to eight-month follow-up data for residents doing PIP only, workshop only, both PIP and workshop, and controls. No significant differences were detected among groups. Interrater reliability for the tool was good.
No difference was found between intervention residents and controls in the assessment of their ability to apply improvement knowledge. This suggests that workshops and PIPs alone will not lead to competence in PBLI. Building this competency likely will require more emphasis on experiential learning and resident participation in health care improvement projects.
毕业后医学教育认证委员会已认可基于实践的学习与改进（PBLI）作为住院医师的一项核心能力。自20世纪90年代初以来，卫生专业教育工作者一直寻求将质量改进原则、方法和技能纳入培训项目。一项文献综述表明，关于如何最好地培训医生以引领患者护理改进方面仍存在问题。通过比较参与的住院医师与对照组的表现，对两种PBLI教育干预措施的效果进行了检验。
实施个人改进项目（PIPs）和一个工作坊，向内科住院医师传授PBLI。门诊轮转的住院医师被要求完成一个PIP。邀请所有住院医师参加工作坊。既不参与PIP也不参加工作坊的住院医师作为对照组。
使用一种工具在项目完成时评估PIP参与者以及六到八个月后的所有住院医师的应用改进知识情况。方差分析表明，项目完成时PIP参与者的表现与六到八个月后的PIP参与者及对照组的表现之间没有差异。第二项分析比较了仅进行PIP、仅参加工作坊、既进行PIP又参加工作坊以及对照组的住院医师六到八个月后的随访数据。各小组之间未检测到显著差异。该工具的评分者间信度良好。
在评估干预组住院医师与对照组应用改进知识的能力方面未发现差异。这表明仅靠工作坊和PIP不会带来PBLI方面的能力提升。培养这种能力可能需要更加强调体验式学习以及住院医师参与医疗保健改进项目。
