Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
BMC Med Educ. 2013 Aug 14;13:109. doi: 10.1186/1472-6920-13-109.
The overuse of laboratory tests and radiology imaging and their possible hazards to patients and the health care system is observed with growing concern in the medical community. With this study the authors wished to determine whether ordering patterns for laboratory and radiology tests by medical students close to their graduation are related to undergraduate training.
We developed an assessment for near graduates in the setting of a resident's daily routine including a consultation hour with five simulated patients, three hours for patient work up with simulated distracting tasks, and thirty minutes for reporting of patient management to a supervisor. In 2011, 60 students participated in this assessment: 30 from a vertically integrated (VI) curriculum (Utrecht, The Netherlands) and 30 from a traditional, non-VI curriculum (Hamburg, Germany). We assessed and compared the number of laboratory and radiology requests and correlated the results with the scores participants received from their supervisors for the facet of competence "scientifically and empirically grounded method of working".
Students from a VI curriculum used significantly (p < .01) less total laboratory requests (N = 283 versus N = 466) which correlated with their scores for a "scientifically and empirically grounded method of working" (Pearson's r = .572). A significantly (p < .01) higher number of radiology imaging was ordered with a large effect size (V = .618) by near graduates from a non-VI curriculum (N = 156 versus N = 97) even when this was not supporting the diagnostic process.
The focused ordering patterns from VI students might be a result of their early exposure to the clinical environment and a different approach to clinical decision making during their undergraduate education which further studies should address in greater detail.
实验室检查和影像学检查的过度使用及其可能对患者和医疗体系造成的危害，引起了医学界越来越多的关注。本研究旨在确定医学生临近毕业时的实验室检查和影像学检查的开具模式是否与本科培训有关。
我们在住院医师日常工作环境中为即将毕业的学生设计了一项评估，包括与五名模拟患者的会诊时间、三小时模拟干扰任务下的患者检查以及三十分钟向主管报告患者管理情况。2011 年，有 60 名学生参加了这项评估：30 名来自垂直整合（VI）课程（荷兰乌得勒支），30 名来自传统的非 VI 课程（德国汉堡）。我们评估并比较了实验室和影像学检查的数量，并将结果与学生从主管那里获得的“科学和经验为基础的工作方法”方面的得分进行了相关性分析。
来自 VI 课程的学生开具的总实验室申请数量明显减少（N = 283 与 N = 466），这与他们在“科学和经验为基础的工作方法”方面的得分相关（Pearson r =.572）。非 VI 课程的医学生临近毕业时开具的影像学检查数量明显更多（p <.01），具有较大的效应量（V =.618），尽管这并没有支持诊断过程。
VI 课程学生的集中式申请模式可能是由于他们早期接触临床环境以及在本科教育中对临床决策制定的不同方法所致，进一步的研究应该更详细地探讨这一点。
