内科医疗查房能力——一项关于可托付专业活动（EPA）跨专业发展的访谈研究
Medical ward round competence in internal medicine - an interview study towards an interprofessional development of an Entrustable Professional Activity (EPA).
作者信息
Wölfel Teresa, Beltermann Esther, Lottspeich Christian, Vietz Elisa, Fischer Martin R, Schmidmaier Ralf
机构信息
Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336, Munich, Germany.
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Ziemssenstrasse 1, 80336, Munchen, Germany.
出版信息
BMC Med Educ. 2016 Jul 11;16:174. doi: 10.1186/s12909-016-0697-y.
BACKGROUND
The medical ward round is a central but complex activity that is of relevance from the first day of work. However, difficulties for young doctors have been reported. Instruction of ward round competence in medical curricula is hampered by the lack of a standardized description of the procedure. This paper aims to identify and describe physicians' tasks and relevant competences for conducting a medical ward round on the first day of professional work.
METHODS
A review of recent literature revealed known important aspects of medical ward rounds. These were used for the development of a semi-structured interview schedule. Medical ward round experts working at different hospitals were interviewed. The sample consisted of 14 ward physicians (M = 8.82 years of work experience) and 12 nurses (M = 14.55 years of work experience) working in different specializations of internal medicine. All interviews were audiotaped, fully transcribed, and analyzed using an inductive-deductive coding scheme.
RESULTS
Nine fields of competences with 18 related sub-competences and 62 observable tasks were identified as relevant for conducting a medical ward round. Over 70 % of the experts named communication, collaborative clinical reasoning and organization as essential competences. Deeper analysis further unveiled the importance of self-management, management of difficult situations, error management and teamwork.
CONCLUSION
The study is the first to picture ward round competences and related tasks in detail and to define an EPA "Conducting an internal medicine ward round" based on systematic interprofessional expert interviews. It thus provides a basis for integration of ward round competences in the medical curricula in an evidence based manner and gives a framework for the development of instructional intervention studies and comparative studies in other medical fields.
背景
医疗查房是一项核心但复杂的活动，从工作的第一天起就具有重要意义。然而，有报道称年轻医生在这方面存在困难。由于缺乏对该流程的标准化描述，医学课程中查房能力的教学受到了阻碍。本文旨在识别和描述医生在专业工作第一天进行医疗查房的任务和相关能力。
方法
对近期文献的回顾揭示了医疗查房的已知重要方面。这些被用于制定一份半结构化访谈提纲。对在不同医院工作的医疗查房专家进行了访谈。样本包括14名内科不同专科的病房医生（工作经验中位数为8.82年）和12名护士（工作经验中位数为14.55年）。所有访谈都进行了录音、全文转录，并使用归纳 - 演绎编码方案进行分析。
结果
确定了九个能力领域，包括18个相关子能力和62项可观察到的任务，这些与进行医疗查房相关。超过70%的专家将沟通、协作临床推理和组织列为基本能力。进一步分析还揭示了自我管理、困难情况管理、错误管理和团队合作的重要性。
结论
该研究首次详细描绘了查房能力和相关任务，并基于系统的跨专业专家访谈定义了一个“进行内科病房查房”的实践能力评估（EPA）。因此，它为以循证方式将查房能力整合到医学课程中提供了基础，并为其他医学领域的教学干预研究和比较研究的开展提供了框架。
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