Emergency Care, North Shore Hospital, Auckland, New Zealand.
Emerg Med Australas. 2010 Aug;22(4):301-9. doi: 10.1111/j.1742-6723.2010.01300.x.
Supervision of junior doctors in ED is vital but limited literature exists on how it is provided.
To assess Australasian ED supervision and review regional legislature supervision requirements.
Between December 2008 and June 2009 emails containing a link to a cross-sectional survey were sent to Directors of Emergency Medicine Training in all Australasian ED accredited for advanced training. Non-responding ED were subsequently contacted by telephone or email. Regional legislature supervision requirements were obtained from postgraduate medical councils.
A total of 103 (98.1%) of 105 ED participated. Senior review in person was mandatory in 43.2% of ED for patients of PGY1 (postgraduate year 1 doctors) and 6.1% of ED for patients of PGY2 (P < 0.001). Of ED without mandatory review, 13% had written guidelines detailing which patients required review. When ED consultants were on-site, they most commonly provided supervision in 60.2% of ED and shared supervision equally with registrars in 35.7% of ED; when consultants were off-site registrars most commonly provided supervision in 87.6% of ED. Fewer major regional/rural base hospitals had 24 h PGY3 or above supervision than major referral and urban district hospitals (82.6% vs 100% and 100%, P < 0.01). Regional legislature requirements varied with no universal guidelines.
There are significant differences between supervision requirements for PGY1 and PGY2. A minority of ED in Australasia do not have 24 h supervision by PGY3 or higher. Few ED have written guidelines for supervising PGY1 and PGY2. The majority of registrar supervision occurs without consultant oversight. Legislature requirements for supervision in ED are variable between regions.
对急诊医生的监督至关重要，但关于监督方式的文献却很少。
评估澳大利亚和亚洲急诊监督情况，并审查区域立法监督要求。
2008 年 12 月至 2009 年 6 月，向所有澳大利亚和亚洲接受高级培训的急诊医学培训主任发送包含横断面调查链接的电子邮件。对未回复的急诊进行电话或电子邮件联系。从毕业后医学委员会获得区域立法监督要求。
共有 105 个急诊参与（103 个，占 98.1%）。对于 PGY1 患者，43.2%的急诊必须进行亲自高级审查，而 6.1%的急诊对于 PGY2 患者进行高级审查（P < 0.001）。在没有强制性审查的急诊中，13%的急诊有详细说明哪些患者需要审查的书面指南。当急诊顾问在场时，他们最常在 60.2%的急诊中提供监督，而在 35.7%的急诊中与住院医师平等分享监督；当顾问不在场时，住院医师最常在 87.6%的急诊中提供监督。与主要转诊和城市地区医院相比，较少的主要地区/农村基础医院有 24 小时 PGY3 或以上的监督（82.6%比 100%和 100%，P < 0.01）。区域立法要求各不相同，没有统一的指导方针。
PGY1 和 PGY2 的监督要求存在显著差异。澳大利亚和亚洲的少数急诊没有由 PGY3 或更高水平医生提供的 24 小时监督。很少有急诊有监督 PGY1 和 PGY2 的书面指南。住院医师的监督大部分是在没有顾问监督的情况下进行的。急诊立法监督要求在不同地区之间存在差异。
