Kyei Mark, Lavelle Ellen, Kyasa Jameel, Safar Mazin, Makhoul Issam, Mehta Paulette
Division of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Cancer Educ. 2010 Sep;25(3):437-41. doi: 10.1007/s13187-010-0069-y.
We developed an integrative component of the consult rotation for fellows training in hematology/oncology. This component consisted of triaging all consults to the hematology/oncology service of the CAVHS during a 1-year period of time. The goals of the rotation were to improve timeliness of response to consultation requests, to gain experience in differential diagnosis of patients with potential hematologic/oncologic disorders through of such patients, review of decisions with attending physicians, and communication of such with the referring physician. The major benefits were that fellows integrated didactic learning into real-life clinical cases, selected patients for their continuity clinic to assure sufficient variety and complexity of cases, honed their communication skills, learned about referring and attending physicians' styles, and gained practice in clinical vignettes representative of cases they would be expected to see in clinical practice. Disadvantages were time involvement (approximately 2 h/day) and risks of over- or under-referrals. Administratively, there was a significant decline in the wait time for patients to be seen in the hematology/oncology service. In all, this elective is a valuable integrative experience of senior fellows, but may have less value for first year fellows.
我们为血液学/肿瘤学专业培训的研究员开发了会诊轮转的综合组成部分。该组成部分包括在为期1年的时间里，对所有转介至CAVHS血液学/肿瘤学服务部门的会诊进行分类。轮转的目标是提高对会诊请求的响应及时性，通过对这类患者的诊疗，获得对潜在血液学/肿瘤学疾病患者进行鉴别诊断的经验，与主治医生一起回顾决策过程，并与转诊医生进行沟通。主要益处在于，研究员将理论学习融入到实际临床病例中，为他们的连续性门诊挑选患者，以确保病例有足够的多样性和复杂性，磨练他们的沟通技巧，了解转诊医生和主治医生的风格，并在代表他们在临床实践中可能遇到的病例的临床案例中获得实践经验。缺点是需要投入时间（大约每天2小时）以及存在转诊过多或过少的风险。在管理方面，血液学/肿瘤学服务部门中患者的等待时间显著缩短。总体而言，这项选修课对高年级研究员来说是一次宝贵的综合体验，但对一年级研究员可能价值较小。
