Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
J Gen Intern Med. 2010 Sep;25 Suppl 4(Suppl 4):S627-33. doi: 10.1007/s11606-010-1404-z.
Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal.
To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs.
One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents' baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling.
The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported.
Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers.
We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness.
临床指南建议医生就饮食和运动对患者进行咨询，但医生的咨询仍然不尽如人意。
确定将绩效改进 (PI) 方法纳入内科 (IM) 住院医师营养和运动咨询课程需求评估中是否可行，并增强我们对课程需求的理解。
158 名 IM 住院医师完成了一份问卷，以评估他们关于高血压患者营养和运动咨询的知识、态度和实践 (KAP)。还通过图表摘录获得了居民的基线营养和运动咨询率。住院医师绘制了鱼骨图以划定饮食和运动咨询的感知障碍。
使用描述性统计方法分析 KAP 问卷。图表摘录数据绘制成运行图，并计算平均咨询率。从鱼骨图中生成帕累托图，显示每个障碍被报告的次数。
几乎 90%的住院医师在 KAP 问卷中报告说，他们会经常（超过 20%的时间）对高血压患者进行饮食和运动咨询。相比之下，图表摘录显示营养和运动的平均咨询率分别为 3%和 4%。KAP 问卷揭示了临床知识不足、对国家指南不熟悉以及自我效能感低的问题。相比之下，鱼骨图分析突出了患者的冷漠、患者的合并症和时间压力作为主要的感知障碍。
我们发现，将 PI 方法纳入内科住院医师心血管疾病风险患者营养和运动咨询课程需求评估中是可行的，提供了通过其他方式无法获得的额外信息，并为试点使用 PI 技术作为教育策略和衡量结果的手段提供了机会。我们的研究结果表明，利用 PI 原则为开发和实施医学教育课程以及衡量其效果提供了有用的框架。
