Vaillancourt Samuel, Schultz Susan E, Leaver Chad, Stukel Thérèse A, Schull Michael J
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2013 Jan;15(1):34-41. doi: 10.2310/8000.2012.120617.
Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief "emergency medicine primer" (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. We sought to determine the effect of the EMP on the ED work intensity of family physicians.
A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. We conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and pre-EMP ED work intensity.
Postcourse, EMP physicians worked 0.5 more ED shifts per month (13% increase, p = 0.027). Compared to their matched controls, EMP physicians worked 0.7 more shifts per month (13% increase, p = 0.0032) and saw 15 more patients per month (17% increase, p = 0.0008) compared to matched non-EMP physicians. The greatest increases were among EMP physicians who were younger, were urban, had previous ED experience, or worked in a high-volume ED. The effect of the EMP course was negligible for physicians with no previous ED experience or working in rural areas.
The EMP course is associated with modest increases in ED work intensity among some family physicians, in particular younger physicians in urban areas. No increase was seen among physicians without previous ED experience or working in rural areas.
最近，许多加拿大急诊科都在努力应对医生人员短缺的问题。2006年，安大略省卫生和长期护理部为家庭医生资助了一个简短的“急诊医学入门”（EMP）课程，以提升或更新技能，目标是提高他们在急诊科的工作强度。我们试图确定EMP课程对家庭医生在急诊科工作强度的影响。
对2006年至2008年完成EMP课程后至少6个月至2年的239名家庭医生在课程前后两年的急诊科工作情况进行回顾性纵向研究，并与未参加EMP课程的医生进行比较。急诊科工作强度定义为每月的急诊轮班次数和每月诊治的急诊患者数量。我们进行了两项分析：对所有EMP医生进行前后比较，以及进行匹配队列分析，将每位EMP医生与四名在性别、医学院毕业年份、是否在农村地区以及EMP课程前的急诊科工作强度方面相匹配的非EMP医生进行匹配。
课程结束后，EMP医生每月多上0.5个急诊轮班（增加13%，p = 0.027）。与匹配的对照组相比，EMP医生每月多上0.7个轮班（增加13%，p = 0.0032），每月多看15名患者（增加17%，p = 0.0008）。增幅最大的是年龄较小、在城市地区、有急诊工作经验或在高流量急诊科工作的EMP医生。对于没有急诊工作经验或在农村地区工作的医生，EMP课程的效果可忽略不计。
EMP课程与部分家庭医生，特别是城市地区的年轻医生在急诊科工作强度的适度增加有关。没有急诊工作经验或在农村地区工作的医生工作强度没有增加。
