Blanchard May Hsieh, Ramsey Patrick S, Gala Rajiv B, Gyamfi Bannerman Cynthia, Srinivas Sindhu K, Hernandez-Rey Armando E
J Grad Med Educ. 2012 Jun;4(2):190-5. doi: 10.4300/JGME-D-11-00135.1.
The liability crisis may affect residency graduates' practice decisions, yet structured liability education during residency is still inadequate. The objective of this study was to determine the influence of medical liability on practice decisions and to evaluate the adequacy of current medical liability curricula.
All fourth-year residents (n = 1274) in 264 Accreditation Council for Graduate Medical Education-accredited allopathic and 25 osteopathic US obstetrics and gynecology residency training programs were asked to participate in a survey about postgraduate plans and formal education during residency regarding liability issues in 2006. Programs were identified by the Council on Resident Education in Obstetrics and Gynecology directory and the American College of Osteopathic Obstetricians and Gynecologists residency program registry. Outcome measures were the reported influence of liability/malpractice concerns on postresidency practice decision making and the incidence of formal education in liability/malpractice issues during residency.
A total of 506 of 1274 respondents (39.7%) returned surveys. Women were more likely than men to report "region of the country" (P = .02) and "paid malpractice insurance as a salaried employee" (P = .03) as a major influence. Of the respondents, 123 (24.3%) planned fellowship training, and 229 (45.3%) were considering limiting practice. More than 20% had been named in a lawsuit. Respondents cited Pennsylvania, Florida, and New York as locations to avoid. In response to questions about medical liability education, 54.3% reported formal education on risk management, and 65.2% indicated they had not received training on "next steps" after a lawsuit.
Residents identify liability-related issues as major influences when making choices about practice after training. Structured education on matters of medical liability during residency is still inadequate.
责任危机可能会影响住院医师培训毕业生的执业决策，但住院医师培训期间系统的责任教育仍显不足。本研究的目的是确定医疗责任对执业决策的影响，并评估当前医疗责任课程的充分性。
2006年，向264个经毕业后医学教育认证委员会认证的美国全科医学以及25个整骨疗法的妇产科住院医师培训项目中的所有四年级住院医师（n = 1274）发放了一份关于研究生计划以及住院医师培训期间有关责任问题的正规教育的调查问卷。这些项目通过妇产科住院医师教育委员会名录以及美国整骨疗法妇产科医生学会住院医师项目登记册确定。结果指标为责任/医疗事故担忧对住院医师培训后执业决策的影响报告，以及住院医师培训期间责任/医疗事故问题正规教育的发生率。
1274名受访者中有506人（39.7%）回复了调查问卷。女性比男性更有可能将“国家地区”（P = 0.02）和“作为受薪雇员支付医疗事故保险”（P = 0.03）列为主要影响因素。在受访者中，123人（24.3%）计划参加专科培训，229人（45.3%）正在考虑限制执业范围。超过20%的人曾被卷入诉讼。受访者提到宾夕法尼亚州、佛罗里达州和纽约州是应避开的地区。在回答有关医疗责任教育的问题时，54.3%的人报告接受过风险管理方面的正规教育，65.2%的人表示他们没有接受过诉讼后“后续步骤”的培训。
住院医师在做出培训后执业选择时，将与责任相关的问题视为主要影响因素。住院医师培训期间关于医疗责任问题的系统教育仍然不足。
