Kwok Stephanie, Ostermeyer Britta, Coverdale John
J Grad Med Educ. 2012 Sep;4(3):296-300. doi: 10.4300/JGME-D-11-00184.1.
The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue.
The authors searched published English-language literature using PubMed and Scopus databases using key terms including "patient," "assaults," "threats," "violence," "aggression," and "residents." A separate search to identify curricula used the same terms in combination with key words including "curriculum," "didactics," and "course." Bibliographies of studies found by electronic searches were also searched manually.
Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath.
Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.
本研究旨在系统回顾关于各专业住院医师遭受患者攻击的发生率的文献，并确定针对该问题的课程。
作者使用PubMed和Scopus数据库检索已发表的英文文献，检索关键词包括“患者”“攻击”“威胁”“暴力”“侵犯”和“住院医师”。另一个用于确定课程的检索使用了相同的术语，并结合了包括“课程”“教学法”和“课程设置”等关键词。对通过电子检索找到的研究的参考文献也进行了手动检索。
15项研究符合纳入标准。其中，7项仅针对精神科住院医师开展，6项评估了非精神科专业住院医师遭受的攻击，2项报告了跨专业数据。攻击发生率定义为经历过至少一次攻击的住院医师的百分比。外科住院医师遭受身体攻击的发生率为38%，急诊医学为26%，内科为16%至40%，儿科为5%至9%，精神科为25%至64%。所有研究均为横断面研究；无一前瞻性收集数据。攻击的定义各异或未明确规定。很少有攻击事件报告给临床督导或培训主任，且没有项目有正式的报告流程。约21%至79%的精神科住院医师和30%的其他专业住院医师接受过如何处理暴力患者的一些培训。我们未发现关于管理患者对住院医师暴力可能性或应对后果的正式课程的描述。
尽管数据有限，但住院医师培训期间普遍会经历患者的攻击。关于降低这些事件发生率以及应对潜在心理后果的信息和课程匮乏，尤其是在非精神科专业。
