School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Institute of Work Psychology (IWP), Sheffield University Management School, University of Sheffield, Sheffield, UK.
Postgrad Med J. 2017 Jan;93(1095):15-19. doi: 10.1136/postgradmedj-2016-133973. Epub 2016 Jun 15.
To examine the delivery of postgraduate training in the emergency medicine setting and its impact on postgraduate doctor (Foundation Year 2) performance and competence.
A national study in four emergency departments (EDs) in England between 2009 and 2010 was undertaken. Semistructured interviews with ED training leads (TLs) and focus groups with Foundation Year 2 (F2) doctors were carried out in each ED. Interviews and focus group data were analysed to compare the perspectives of F2 doctors and TLs on the delivery of training and performance and confidence of F2 doctors.
Interviews were carried out with eight TLs and focus groups with 30 F2s. F2 doctors and EDTLs agreed that ED was a valuable environment for F2 doctors to develop their competence, with exposure to a broad range of patients and the opportunity to make decisions about clinical care. Diverging views existed around competence and performance of F2s. F2 doctors had anxieties about decision-making (particularly discharging patients) and required regular feedback to feel confident in their care. TLs recognised a need for more supervision and support for F2 doctors but this was challenging in a busy, performance-led service.
Emergency medicine placements were important in the development of confident and competent F2 doctors, particularly in the context of less clinical exposure in other specialty placements. However, there are competing tensions between elements of postgraduate learning and service delivery within emergency medicine that require addressing to enable trainees to optimally develop knowledge and skills in this environment.
考察急诊环境下的研究生培训及其对住院医师（基础培训 2 年）表现和能力的影响。
2009 年至 2010 年在英格兰的四个急诊部进行了一项全国性研究。在每个急诊部，对急诊培训负责人（TL）进行半结构式访谈，并对基础培训 2 年（F2）医生进行焦点小组讨论。对访谈和焦点小组数据进行分析，以比较 F2 医生和 TLs 对培训的交付、F2 医生的表现和信心的看法。
对 8 名 TL 进行了访谈，对 30 名 F2 进行了焦点小组讨论。F2 医生和急诊 TL 一致认为，急诊是 F2 医生发展能力的宝贵环境，使他们接触到广泛的患者，并有机 会就临床护理做出决策。F2 医生的能力和表现存在分歧观点。F2 医生对决策（特别是对患者的出院）感到焦虑，需要定期反馈才能对自己的护理有信心。TL 认识到需要为 F2 医生提供更多的监督和支持，但在繁忙的、以绩效为导向的服务中，这是具有挑战性的。
急诊实习对培养自信和有能力的 F2 医生非常重要，特别是在其他专业实习中临床接触较少的情况下。然而，急诊医学中的研究生学习和服务交付的各个要素之间存在竞争紧张关系，需要加以解决，以使受训者能够在这一环境中最佳地发展知识和技能。
