澳大利亚全科医生培训学员向全科医生培训师进行会诊咨询及寻求建议的情况——一项横断面分析

In-consultation information and advice-seeking by Australian GP trainees from GP trainers - a cross-sectional analysis.

作者信息

Morgan Simon, Wearne Susan, Tapley Amanda, Henderson Kim, Oldmeadow Chris, Ball Jean, van Driel Mieke, Scott John, Spike Neil, McArthur Lawrie, Magin Parker

机构信息

General Practitioner and Medical Educator, General Practice Training Valley to Coast, PO Box 573, HRMC, NSW 2310, Australia.

Senior Lecturer in Clinical Educator Development, Flinders University, Supervisor Research & Development, Australian National University Medical School and General Practice Education and Training (GPET), Canberra, Australia.

出版信息

Educ Prim Care. 2015 May;26(3):155-65. doi: 10.1080/14739879.2015.11494335.

DOI:10.1080/14739879.2015.11494335

PMID:26092144

Abstract

INTRODUCTION

The apprenticeship model of general practice (GP) training is based on appropriate supervision. A central component of supervision - in-consultation information-seeking of GP trainees from their trainer - has not been documented. We aimed to establish the prevalence, characteristics and associations (trainee, practice, patient and consultation) of this information-seeking.

METHODS

Australian trainees recorded demographic, clinical and educational details of 60 consecutive consultations in each GP term of their training, including the rate and nature of information-seeking.

RESULTS

Six-hundred and forty-five trainees contributed data for 1426 trainee-rounds, 84 723 consultations and 131 583 problems. Information was sought from the trainer for 9130 (6.9% (95% CI 6.8-7.1)) of all problems encountered (and in 7833 (9.2% (95% CI 9.0-9.4)) of consultations): 11.7% (95% CI 11.0- 12.4) were for diagnosis, 53.1% (95% CI 52.1-54.2) for management and 35.2% (95% CI 34.2-36.2) for both diagnosis and management. Assistance was sought most commonly for skin problems (20.0%) and musculoskeletal problems (12.6%). Significant adjusted associations of information-seeking included patient age; male patient gender; earlier training term; trainee being younger and female; trainee's training organisation; longer consultation; and trainee generation of learning goals.

DISCUSSION

Our findings have implications for trainer workload and professional development, patient care and trainee education and training.

摘要

引言

全科医学（GP）培训的学徒模式基于适当的监督。监督的一个核心组成部分——全科医学实习生在会诊时向带教老师寻求信息——尚未被记录在案。我们旨在确定这种信息寻求行为的发生率、特征以及相关因素（实习生、诊所、患者和会诊）。

方法

澳大利亚的实习生记录了他们培训期间每个全科医学学期连续60次会诊的人口统计学、临床和教育细节，包括信息寻求的频率和性质。

结果

645名实习生提供了1426个实习生轮次、84723次会诊和131583个问题的数据。在所有遇到的问题中，有9130个（6.9%（95%置信区间6.8 - 7.1））向带教老师寻求了信息（在7833次会诊中为9.2%（95%置信区间9.0 - 9.4））：11.7%（95%置信区间11.0 - 12.4）是为了诊断，53.1%（95%置信区间52.1 - 54.2）是为了管理，35.2%（95%置信区间34.2 - 36.2）是为了诊断和管理。最常寻求帮助的是皮肤问题（20.0%）和肌肉骨骼问题（12.6%）。信息寻求的显著校正相关因素包括患者年龄；男性患者性别；较早的培训学期；较年轻和女性的实习生；实习生的培训机构；较长的会诊时间；以及实习生制定学习目标。