University of Virginia Health System (UVAHS), Charlottesville, VA, USA.
J Gen Intern Med. 2011 Jan;26(1):16-20. doi: 10.1007/s11606-010-1437-3. Epub 2010 Jul 14.
Many have called for ambulatory training redesign in internal medicine (IM) residencies to increase primary care career outcomes. Many believe dysfunctional, clinic environments are a key barrier to meaningful ambulatory education, but little is actually known about the educational milieu of continuity clinics nationwide.
We wished to describe the infrastructure and educational milieu at resident continuity clinics and assess clinic readiness to meet new IM-RRC requirements.
National survey of ACGME accredited IM training programs.
Directors of academic and community-based continuity clinics.
Two hundred and twenty-one out of 365 (62%) of clinic directors representing 49% of training programs responded. Wide variation amongst continuity clinics in size, structure and educational organization exist. Clinics below the 25th percentile of total clinic sessions would not meet RRC-IM requirements for total number of clinic sessions. Only two thirds of clinics provided a longitudinal mentor. Forty-three percent of directors reported their trainees felt stressed in the clinic environment and 25% of clinic directors felt overwhelmed.
The survey used self reported data and was not anonymous. A slight predominance of larger clinics and university based clinics responded. Data may not reflect changes to programs made since 2008.
This national survey demonstrates that the continuity clinic experience varies widely across IM programs, with many sites not yet meeting new ACGME requirements. The combination of disadvantaged and ill patients with inadequately resourced clinics, stressed residents, and clinic directors suggests that many sites need substantial reorganization and institutional commitment.New paradigms, encouraged by ACGME requirement changes such as increased separation of inpatient and outpatient duties are needed to improve the continuity clinic experience.
许多人呼吁对内科住院医师培训进行门诊培训设计改革，以增加初级保健职业成果。许多人认为功能失调的诊所环境是进行有意义的门诊教育的关键障碍，但实际上对于全国范围内的连续性诊所的教育环境知之甚少。
我们希望描述住院医师连续性诊所的基础设施和教育环境，并评估诊所是否有能力满足新的内科住院医师培训委员会（IM-RRC）的要求。
对 ACGME 认证的内科培训计划进行的全国性调查。
学术和基于社区的连续性诊所主任。
代表 49%培训计划的 365 名（62%）诊所主任中的 221 名做出了回应。连续性诊所的规模、结构和教育组织存在很大差异。诊所的总诊次低于 25%，则无法满足 RRC-IM 对总诊次的要求。只有三分之二的诊所提供了纵向导师。43%的主任报告说，他们的受训者在诊所环境中感到压力，25%的诊所主任感到不知所措。
该调查使用自我报告的数据，且并非匿名。回答的诊所略偏向于较大的诊所和大学附属医院。数据可能无法反映自 2008 年以来对项目的更改。
这项全国性调查表明，内科住院医师培训计划中的连续性诊所经验差异很大，许多基地尚未满足新的 ACGME 要求。患有不利条件和疾病的患者与资源不足的诊所、压力大的住院医师以及诊所主任相结合，表明许多基地需要进行大量的重组和机构承诺。需要新的模式，例如 ACGME 要求的改变，如增加住院和门诊职责的分离，以改善连续性诊所的体验。
