Wack Maxime, Puymirat Etienne, Ranque Brigitte, Georgin-Lavialle Sophie, Pierre Isabelle, Tanguy Aurelia, Ackermann Felix, Mallet Celine, Pavie Juliette, Boultache Hakima, Durieux Pierre, Avillach Paul
Biomedical informatics and public health department, HEGP, AP-HP, Paris Descartes University, Paris, France; INSERM UMR S 872 team 22, Faculté de Médecine, Paris Descartes University, Paris, France.
Departement of Cardiology, HEGP, AP-HP, Paris Descartes University, Paris, France; INSERM U-970, Faculté de Médecine, Paris Descartes University, Paris, France.
PLoS One. 2015 Sep 14;10(9):e0138094. doi: 10.1371/journal.pone.0138094. eCollection 2015.
To evaluate the impact of computerized provider order entry (CPOE) at the bedside on medical students training.
We conducted a randomized cross-controlled educational trial on medical students during two clerkship rotations in three departments, assessing the impact of the use of CPOE on their ability to place adequate monitoring and therapeutic orders using a written test before and after each rotation. Students' satisfaction with their practice and the order placement system was surveyed. A multivariate mixed model was used to take individual students and chief resident (CR) effects into account. Factorial analysis was applied on the satisfaction questionnaire to identify dimensions, and scores were compared on these dimensions.
Thirty-six students show no better progress (beginning and final test means = 69.87 and 80.98 points out of 176 for the control group, 64.60 and 78.11 for the CPOE group, p = 0.556) during their rotation in either group, even after adjusting for each student and CR, but show a better satisfaction with patient care and greater involvement in the medical team in the CPOE group (p = 0.035*). Both groups have a favorable opinion regarding CPOE as an educational tool, especially because of the order reviewing by the supervisor.
This is the first randomized controlled trial assessing the performance of CPOE in both the progress in prescriptions ability and satisfaction of the students. The absence of effect on the medical skills must be weighted by the small time scale and low sample size. However, students are more satisfied when using CPOE rather than usual training.
评估床边计算机医嘱录入(CPOE)对医学生培训的影响。
我们在三个科室的两轮临床实习期间对医学生进行了一项随机交叉对照教育试验,通过在每次轮转前后进行书面测试,评估使用CPOE对他们下达适当监测和治疗医嘱能力的影响。调查了学生对其实习和医嘱下达系统的满意度。使用多变量混合模型考虑个体学生和总住院医师(CR)的影响。对满意度问卷进行因子分析以确定维度,并比较这些维度上的得分。
36名学生在任何一组轮转期间均未表现出更好的进步(对照组初始和最终测试平均分在176分中分别为69.87分和80.98分,CPOE组为64.60分和78.11分,p = 0.556),即使在对每个学生和CR进行调整之后也是如此,但CPOE组学生对患者护理的满意度更高,且在医疗团队中的参与度更高(p = 0.035*)。两组对CPOE作为一种教育工具都有良好的评价,特别是因为有上级的医嘱审核。
这是第一项评估CPOE在学生处方能力进展和满意度方面表现的随机对照试验。对医疗技能缺乏影响这一点必须结合时间尺度小和样本量低的情况来权衡。然而,学生在使用CPOE时比接受常规培训时更满意。