Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Acad Emerg Med. 2011 Oct;18 Suppl 2:S71-8. doi: 10.1111/j.1553-2712.2011.01174.x.
Many factors affect the clinical training experience of emergency medicine (EM) residents, and length of training currently serves as a proxy for clinical experience. Very few studies have been published that provide quantitative information about clinical experience. The goals of this study were to determine the numbers of clinical encounters for each resident in emergency department (ED) rotations during training in a 3-year program, to characterize these encounters by patient acuity and age, to determine the numbers of encounters for selected clinical disorders, and to assess the variation in clinical experience between residents.
This was a retrospective analysis of the ED clinical and administrative databases at two hospitals that provide EM training for a southeastern U.S. EM residency program. Data were gathered for three complete cohorts of residents, with entering years of 2003, 2004, and 2005, so the total study period was 2003-2008. ED clinical encounter information included hospital training site (tertiary or community), postgraduate year (PGY) of the resident, patient triage acuity reflected by the Emergency Severity Index (ESI); patient International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code; and patient age group.
There were 25 residents with 120,240 total ED clinical encounters from 2003 to 2008. The median number of ED clinical encounters for a resident during his or her training was 4,836 (range = 3,831 to 5,780), based on a maximum of an 80-hour work week, and 24 or 25 four-week blocks of EM rotations. Overall, clinical encounters increased by 30% from PGY 1 to PGY 2, and another 14% from PGY 2 to PGY 3. There was 30% to 60% variation in clinical encounters between individual residents. Variability was most prominent in the care of children and in the care of time-sensitive critical illness. Resident encounters with lower-acuity problems during training were much less than the anticipated lower-acuity burden during practice. Additionally, residents did not encounter some high-risk conditions clinically during the study period.
Methods should be developed to decrease resident variance in both numbers and types of clinical encounters and to provide curriculum supplementation for individuals and for the entire residency cohort in areas that are important for the clinical practice of EM, but that are rare or not encountered during residency training.
许多因素会影响急诊医学（EM）住院医师的临床培训体验，而培训时间目前是临床经验的代表。很少有研究提供有关临床经验的定量信息。本研究的目的是确定在 3 年制项目的急诊轮转中每位住院医师的临床接触次数，按患者的病情严重程度和年龄对这些接触进行分类，确定特定临床疾病的接触次数，并评估住院医师之间的临床经验差异。
这是对为美国东南部的急诊医学住院医师培训项目提供服务的两家医院的急诊临床和行政数据库进行的回顾性分析。数据采集涵盖了 2003 年、2004 年和 2005 年进入的三个完整的住院医师队列，因此总研究期间为 2003 年至 2008 年。急诊临床接触信息包括医院培训地点（三级或社区）、住院医师的毕业后年份（PGY）、反映急诊严重程度指数（ESI）的患者分诊严重程度；患者国际疾病分类，第九修订版，临床修正（ICD-9-CM）诊断代码；以及患者年龄组。
2003 年至 2008 年期间，共有 25 名住院医师进行了 120240 次急诊临床接触。住院医师在培训期间的急诊临床接触中位数为 4836 次（范围=3831 至 5780），基于每周最多 80 小时的工作时间和 24 或 25 个为期四周的急诊轮转。总体而言，住院医师从 PGY1 到 PGY2 的临床接触增加了 30%，从 PGY2 到 PGY3 又增加了 14%。个别住院医师之间的临床接触差异在 30%到 60%之间。在儿童护理和时间敏感的危急疾病护理方面，差异最为明显。住院医师在培训期间遇到的低严重程度问题的次数远低于实践中预期的低严重程度负担。此外，在研究期间，住院医师在临床上并未遇到某些高危情况。
应开发方法来减少住院医师在临床接触次数和类型方面的差异，并为个人和整个住院医师群体提供课程补充，以满足急诊医学临床实践中重要但在住院医师培训期间很少遇到或未遇到的领域。
