Goldshore Matthew A, Solomon Barry S, Downs Stephen M, Pan Richard, Minkovitz Cynthia S
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
Acad Pediatr. 2014 Jul-Aug;14(4):341-7. doi: 10.1016/j.acap.2014.02.011. Epub 2014 Jun 3.
To assess how exposures to community activities in residency impact anticipated future involvement in community child health settings.
Prospective cohort study of pediatric residents from 10 programs (12 sites) who completed training between 2003 and 2009. Residents reported annual participation for ≥ 8 days in each of 7 community activities (eg, community settings, child health advocacy) in the prior year. At the start and end of residency, residents reported anticipated involvement in 10 years in 8 community settings (eg, school, shelter). Anticipated involvement was dichotomized: moderate/substantial ("high") versus none/limited ("low"). Logistic regression modeled whether residency exposures independently influenced anticipated future involvement at the end of residency.
A total of 683 residents completed surveys at the start and end of residency (66.8% participation). More than half of trainees reported ≥ 8 days' of involvement in community settings (65.6%) or child health advocacy (53.6%) in residency. Fewer anticipated high involvement in at least 1 community setting at the end of residency than at the start (65.5% vs 85.6%, P < .001). Participation in each community activity mediated but did not moderate relations between anticipated involvement at the start and end of residency. In multivariate models, exposure to community settings in residency was associated with anticipated involvement at end of residency (adjusted odds ratio 1.5; 95% confidence interval 1.2, 2.0). No other residency exposures were associated.
Residents who anticipate high involvement in community pediatrics at the start of residency participate in related opportunities in training. Exposure to community settings during residency may encourage community involvement after training.
评估住院医师阶段参与社区活动如何影响未来参与社区儿童健康工作的预期。
对2003年至2009年期间完成培训的来自10个项目（12个地点）的儿科住院医师进行前瞻性队列研究。住院医师报告前一年中每年参与7项社区活动（如社区场所、儿童健康宣传）中每项活动≥8天的情况。在住院医师阶段开始和结束时，住院医师报告预计10年后参与8种社区场所（如学校、庇护所）工作的情况。预期参与情况分为两类：中度/大量（“高”）与无/有限（“低”）。逻辑回归模型用于分析住院医师阶段的经历是否独立影响住院医师阶段结束时未来参与工作的预期。
共有683名住院医师在住院医师阶段开始和结束时完成了调查（参与率66.8%）。超过一半的受训者报告在住院医师阶段参与社区场所活动≥8天（65.6%）或儿童健康宣传活动≥8天（53.6%）。与住院医师阶段开始时相比，预计在住院医师阶段结束时至少在1个社区场所大量参与工作的人数减少（65.5%对85.6%，P<0.001）。参与每项社区活动在住院医师阶段开始和结束时预期参与情况之间起中介作用，但不起调节作用。在多变量模型中，住院医师阶段接触社区场所与住院医师阶段结束时的预期参与情况相关（调整后的优势比为1.5；95%置信区间为1.2,2.0）。没有其他住院医师阶段的经历与之相关。
在住院医师阶段开始时预计大量参与社区儿科工作的住院医师在培训中会参与相关机会。住院医师阶段接触社区场所可能会鼓励培训后参与社区工作。
