Massachusetts General Hospital, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2012 Aug 1;94(15):e1131-7. doi: 10.2106/JBJS.K.00638.
Despite advances in understanding the "systems-based practice" competency in resident education, this topic has remained difficult to teach, assess, and document. The goal of this study was to perform a needs assessment and an analysis of the current state of systems-based practice education in orthopaedic residency programs across the U.S. and within our own institution.
A sample of orthopaedic educators and residents from across the U.S. who were attending the 2010 American Orthopaedic Association (AOA) Effective Orthopaedic Educator Course, AOA Resident Leadership Forum, and AOA Council of Residency Directors meeting were surveyed to determine (1) which aspects of systems-based practice, if any, were being taught; (2) how systems-based practice is being taught; and (3) how residency programs are assessing systems-based practice. In addition, an in-depth case study of these issues was performed by means of seven semi-structured focus group sessions with diverse stakeholders who participated in the care of musculoskeletal patients at the authors' institution. A quantitative approach was used to analyze the survey data. The focus group data were analyzed with procedures associated with grounded theory, relying on a constant comparative method to develop salient themes arising from the discussion.
"Clinical observation" (33%) and "didactic case-based learning" (23%) were reported by the survey respondents as the most commonly used teaching methods, but specific topics were taught inconsistently. Competency assessment was reported to occur infrequently, and 36% of respondents reported that systems-based practice areas were not being assessed by any methods. The focus group discussions emphasized the need for standardized experiential learning that was closely linked to the patient's perspective. Orthopaedic faculty members were uncomfortable with their knowledge of this competency and their ability to teach and assess it.
Teaching the systems-based practice competency occurs inconsistently, and formal assessment occurs infrequently. In addition to formal teaching, learning systems-based practice will be best achieved experientially and from the patient's perspective.
尽管在住院医师教育中对“基于系统的实践”能力的理解已经取得了进展，但这个主题仍然很难教授、评估和记录。本研究的目的是对美国各地和我们自己机构的骨科住院医师培训计划中的基于系统的实践教育进行需求评估和现状分析。
我们对参加 2010 年美国骨科协会（AOA）有效骨科教育者课程、AOA 住院医师领导论坛和 AOA 住院医师主任会议的美国各地的骨科教育者和住院医师进行了抽样调查，以确定：（1）正在教授哪些方面的基于系统的实践，如果有的话；（2）如何教授基于系统的实践；（3）住院医师计划如何评估基于系统的实践。此外，通过在作者所在机构参与肌肉骨骼患者护理的不同利益相关者的七次半结构化焦点小组会议，对这些问题进行了深入的案例研究。采用定量方法分析调查数据。使用与扎根理论相关的程序对焦点小组数据进行分析，依靠不断比较的方法从讨论中发展出突出的主题。
调查答复者报告说，“临床观察”（33%）和“基于案例的教学”（23%）是最常用的教学方法，但具体的教学主题并不统一。据报道，能力评估很少发生，36%的答复者报告说，基于系统的实践领域没有通过任何方法进行评估。焦点小组讨论强调需要标准化的体验式学习，这种学习与患者的视角密切相关。骨科教师对他们在这一能力方面的知识和教授和评估这一能力的能力感到不舒服。
基于系统的实践能力的教学不一致，正式评估也不频繁。除了正式教学外，从患者的角度体验和学习基于系统的实践将是最好的方法。
