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儿科住院医师质量改进教育:一项全国性调查。

Pediatric resident education in quality improvement (QI): a national survey.

作者信息

Craig Mark S, Garfunkel Lynn C, Baldwin Constance D, Mann Keith J, Moses James M, Co John Patrick T, Blumkin Aaron K, Szilagyi Peter G

机构信息

Department of Pediatrics, University of Rochester Medical Center, Rochester, NY; Department of Pediatrics, Madigan Army Medical Center, Tacoma, Wash.

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, and Rochester General Hospital, Rochester, NY.

出版信息

Acad Pediatr. 2014 Jan-Feb;14(1):54-61. doi: 10.1016/j.acap.2013.10.004.

Abstract

OBJECTIVE

To assess pediatric residents' perceptions of their quality improvement (QI) education and training, including factors that facilitate learning QI and self-efficacy in QI activities.

METHODS

A 22-question survey questionnaire was developed with expert-identified key topics and iterative pretesting of questions. Third-year pediatric residents from 45 residency programs recruited from a random sample of 120 programs. Data were analyzed by descriptive statistics, chi-square tests, and qualitative content analysis.

RESULTS

Respondents included 331 residents for a response rate of 47%. Demographic characteristics resembled the national profile of pediatric residents. Over 70% of residents reported that their QI training was well organized and met their needs. Three quarters felt ready to use QI methods in practice. Those with QI training before residency were significantly more confident than those without prior QI training. However, fewer than half of respondents used standard QI methods such as PDSA cycles and run charts in projects. Residents identified faculty support, a structured curriculum, hands-on projects, and dedicated project time as key strengths of their QI educational experiences. A strong QI culture was also considered important, and was reported to be present in most programs sampled.

CONCLUSIONS

Overall, third-year pediatric residents reported positive QI educational experiences with strong faculty support and sufficient time for QI projects. However, a third of residents thought that the QI curricula in their programs needed improvement, and a quarter lacked self-efficacy in conducting future QI activities. Continuing curricular improvement, including faculty development, is warranted.

摘要

目的

评估儿科住院医师对其质量改进(QI)教育与培训的认知,包括促进QI学习的因素以及在QI活动中的自我效能感。

方法

基于专家确定的关键主题编制了一份包含22个问题的调查问卷,并对问题进行了反复预测试。从120个住院医师培训项目的随机样本中招募了45个项目的三年级儿科住院医师。通过描述性统计、卡方检验和定性内容分析对数据进行分析。

结果

331名住院医师参与了调查,回复率为47%。人口统计学特征与全国儿科住院医师概况相似。超过70%的住院医师表示他们的QI培训组织良好且满足他们的需求。四分之三的人认为自己已准备好在实践中运用QI方法。住院前接受过QI培训的人比未接受过QI培训的人明显更有信心。然而,在项目中使用如计划 - 执行 - 检查 - 处理(PDSA)循环和运行图等标准QI方法的受访者不到一半。住院医师将教员支持、结构化课程、实践项目和专门的项目时间视为其QI教育经历的关键优势。强大的QI文化也被认为很重要,据报告在所抽样的大多数项目中都存在。

结论

总体而言,三年级儿科住院医师报告了积极的QI教育经历,有强大的教员支持和足够的时间用于QI项目。然而,三分之一的住院医师认为他们项目中的QI课程需要改进,四分之一的人在开展未来QI活动时缺乏自我效能感。包括教员发展在内的持续课程改进是必要的。

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