Williams Robert L, Romney Crystal, Kano Miria, Wright Randy, Skipper Betty, Getrich Christina, Susman Andrew L, Zyzanski Stephen J
Department of Family and Community Medicine, University of New Mexico.
Fam Med. 2014 May;46(5):340-7.
Health care reform aims to increase evidence-based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost and comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims.
We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection, or initial chronic disease management scenarios, representing in turn evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses.
Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost conscious and more patient centered. We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes.
This study provides preliminary evidence suggesting that students planning to enter family medicine may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes.
医疗改革旨在增加循证、注重成本和以患者为中心的医疗服务。家庭医学被视为实现这些目标的核心，部分原因是与其他专科相比，有证据表明其成本更低且医疗质量相当。我们试图寻找证据，以证明计划从事家庭医学住院医师培训的高年级医学生在与这些医疗改革目标相关的决策模式上与进入其他领域的同龄人有所不同。
我们对高年级医学生进行了一项全国性、匿名的基于互联网的调查。学生们针对一系列患者案例选择两种等效管理选项之一，这些案例基于预防保健、药物选择或初始慢性病管理场景，依次代表循证医疗、注重成本的医疗和以患者为中心的医疗。我们通过双变量分析以及加权、多层次、多变量分析，比较计划进入家庭医学领域的学生与其他所有学生在推荐意见上的差异。
在从84所参与调查的医学院校的高年级学生中收到的4656份调查问卷中，计划进入家庭医学领域的学生更有可能推荐更注重成本和更以患者为中心的患者管理选项。在循证医疗案例的推荐方面，我们未发现两组学生之间存在显著差异。
本研究提供了初步证据，表明计划进入家庭医学领域的学生可能已经具有临床决策模式，在更大程度上支持医疗改革目标，相较于他们的同龄人。如果其他研究予以证实，这可能会对医学院的招生和培训过程产生影响。
