Wong Brian M, Holmboe Eric S
B.M. Wong is assistant professor of medicine, Department of Medicine, staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and associate director, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada. E.S. Holmboe is senior vice president, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and professor adjunct of medicine, Yale School of Medicine, New Haven, Connecticut.
Acad Med. 2016 Apr;91(4):473-9. doi: 10.1097/ACM.0000000000001035.
The current health care delivery model continues to fall short in achieving the desired patient safety and quality-of-care outcomes for patients. And, until recently, an explicit acknowledgment of the role and influence of the clinical learning environment on professional development had been missing from physician-based competency frameworks. In this Perspective, the authors explore the implications of the insufficient integration of education about patient safety and quality improvement by academic faculty into the clinical learning environment in many graduate medical education (GME) programs, and the important role that academic faculty need to play to better align the educational and clinical contexts to improve both learner and patient outcomes. The authors propose a framework that closely aligns the educational and clinical contexts, such that both educational and clinical outcomes are centered around the patient. This will require a reorganization of academic faculty perspective and educational design of GME training programs that recognizes that (1) the dynamic interplay between the faculty, learner, training program, and clinical microsystem ultimately influences the quality of physician that emerges from the training program and environment, and (2) patient outcomes relate to the quality of education and the success of clinical microsystems. To enable this evolution, there is a need to revisit the core competencies expected of academic faculty, implement innovative faculty development strategies, examine closely faculty's current clinical super vision practices, and establish a training environment that supports bridging from clinician to educator, training program to clinical microsystem, and educational outcomes to clinical outcomes that benefit patients.
当前的医疗服务模式在实现患者期望的患者安全和医疗质量结果方面仍存在不足。而且,直到最近,基于医师的能力框架中一直缺少对临床学习环境对专业发展的作用和影响的明确认可。在这篇观点文章中,作者探讨了许多毕业后医学教育(GME)项目中学术教员对患者安全和质量改进的教育在临床学习环境中整合不足的影响,以及学术教员为更好地使教育与临床环境相匹配以改善学习者和患者结果而需要发挥的重要作用。作者提出了一个将教育与临床环境紧密结合的框架,使教育和临床结果都以患者为中心。这将需要重新调整学术教员的视角和GME培训项目的教学设计,认识到:(1)教员、学习者、培训项目和临床微观系统之间的动态相互作用最终会影响从培训项目和环境中培养出来的医生的质量;(2)患者结果与教育质量和临床微观系统的成功相关。为了实现这一转变,有必要重新审视对学术教员期望的核心能力,实施创新的教员发展策略,仔细检查教员当前的临床监督实践,并建立一个支持从临床医生向教育者、培训项目向临床微观系统、教育结果向有利于患者的临床结果过渡的培训环境。