Owens Sonal T, Owens Gabe E, Rajput Shaili H, Charpie John R, Kidwell Kelley M, Mullan Patricia B
Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich, USA.
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich, USA.
Congenit Heart Dis. 2015 May-Jun;10(3):E107-12. doi: 10.1111/chd.12261. Epub 2015 Apr 15.
The 24/7 in-house attending coverage is emerging as the standard of care in intensive care units. Implementation costs, workforce feasibility, and patient outcomes resulting from changes in physician staffing are widely debated topics. Understanding the impact of staffing models on the learning environment for medical trainees and faculty is equally warranted, particularly with respect to trainee education and autonomy.
This study aims to elicit the perceptions of pediatric cardiology fellows and attendings toward 24/7 in-house attending coverage and its effect on fellow education and autonomy.
We surveyed pediatric cardiology fellows and attendings practicing in the pediatric cardiothoracic intensive care unit (PCTU) of a large, university-affiliated medical center, using structured Likert response items and open-ended questions, prior to and following the transition to 24/7 in-house attending coverage.
All (100%) trainees and faculty completed all surveys. Both prior to and following transition to 24/7 in-house attending coverage, all fellows, and the majority of attendings agreed that the overnight call experience benefited fellow education. At baseline, trainees identified limited circumstances in which on-site attending coverage would be critical. Preimplementation concerns that 24/7 in-house attending coverage would negatively affect the education of fellows were not reflected following actual implementation of the new staffing policy. However, based upon open-ended questions, fellow autonomy was affected by the new paradigm, with fellows and attendings reporting decreased "appropriateness" of autonomy after implementation.
Our prospective study, showing initial concerns about limiting the learning environment in transitioning to 24/7 in-house attending coverage did not result in diminished perceptions of the educational experience for our fellows but revealed an expected decrease in fellow autonomy. The study indirectly facilitated open discussions about methods to preserve fellow education and warranted autonomy in our PCTU; however, continued efforts are needed to achieve the optimal balance between supervised training and the transition to autonomous practice.
全天候住院医师在岗值班正逐渐成为重症监护病房的护理标准。实施成本、劳动力可行性以及医师人员配置变化所带来的患者预后等问题，都是备受广泛争议的话题。同样有必要了解人员配置模式对医学实习生和教员学习环境的影响，尤其是在实习生教育和自主权方面。
本研究旨在了解儿科心脏病学住院医师和主治医师对全天候住院医师在岗值班及其对住院医师教育和自主权影响的看法。
在一家大型大学附属医院的儿科心胸重症监护病房（PCTU）向儿科心脏病学住院医师和主治医师进行调查，在向全天候住院医师在岗值班过渡之前和之后，使用结构化的李克特量表反应项和开放式问题。
所有（100%）实习生和教员都完成了所有调查。在向全天候住院医师在岗值班过渡之前和之后，所有住院医师以及大多数主治医师都认为夜间值班经历对住院医师教育有益。在基线时，实习生确定了现场有主治医师值班至关重要的有限情况。新人员配置政策实际实施后，之前担心全天候住院医师在岗值班会对住院医师教育产生负面影响的情况并未出现。然而，根据开放式问题，住院医师的自主权受到了新范式的影响，住院医师和主治医师报告称实施后自主权的“适当性”有所下降。
我们的前瞻性研究表明，最初对向全天候住院医师在岗值班过渡会限制学习环境的担忧，并未导致我们的住院医师对教育经历的看法降低，但显示出住院医师自主权预期下降。该研究间接促进了关于在我们的PCTU中保持住院医师教育和应有自主权方法的公开讨论；然而，仍需要持续努力以在监督培训和向自主实践过渡之间实现最佳平衡。
