Boots R J, Egerton W, McKeering H, Winter H
Department of Postgraduate Medical Education. Brisbane and Women's Hospitals, Brisbane, Queensland, Australia.
Intern Med J. 2009 Apr;39(4):222-7. doi: 10.1111/j.1445-5994.2009.01699.x.
Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures.
Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined.
For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44-84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation (beta = 0.17, 95% confidence interval (CI) 0.02-0.21, P = 0.03) and age >30 years on commencing internship (beta = 8.44, 95%CI 3.03-14.06, P = 0.003. Adjusted R(2) = 0.08, P = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme (beta = 0.48, 95%CI 0.34-0.62, P < 0.001), intern experience with patient procedures (beta = 0.34, 95%CI 0.21-0.47, P < 0.001) and a clear decision to enter a postgraduate training programme (beta = 0.13, 95%CI 0.04-0.22, P = 0.007, Adjusted R(2) = 0.50, P < 0.001).
Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.
医学院校和住院医师培训项目提供不同的学习机会和结果。本研究旨在评估医学生和实习生在常见临床操作方面的经历。
2000年至2004年在一家大都市教学医院工作的实习生在实习年开始和结束时完成了一项关于临床操作经验和信心的调查。研究了参加自愿性操作技能培训项目的情况及其对操作信心的影响。
对于314名实习生，每项操作在实习前和实习期间的临床经验各不相同，不同年份队列之间也有所不同，培训项目的参与率也不同（44%-84%）。学生的操作信心可通过实习前在患者身上的经验或模拟经验来预测（β = 0.17，95%置信区间（CI）0.02-0.21，P = 0.03），以及开始实习时年龄大于30岁（β = 8.44，95%CI 3.03-14.06，P = 0.003。调整后的R(2) = 0.08，P = 0.002）。到年底时，实习生的操作信心可通过参加培训项目来预测（β = 0.48，95%CI 0.34-0.62，P < 0.001），实习生在患者操作方面的经验（β = 0.34，95%CI 0.21-0.47，P < 0.001），以及明确决定进入研究生培训项目（β = 0.13，95%CI 0.04-0.22，P = 0.007，调整后的R(2) = 0.50，P < 0.001）。
实习生和学生在对患者进行操作技能方面获得的经验各不相同。这使得设计培训项目变得困难，因为每年的培训需求都有所不同。在实习年期间，既需要对关键技能进行强制性监督，也需要有机会补充有限的经验，以确保获得统一的经验。
