Gupta Shruti, Alladina Jehan, Heaton Kevin, Miloslavsky Eli
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
BMC Med Educ. 2016 Oct 20;16(1):276. doi: 10.1186/s12909-016-0796-9.
Subspecialty fellows can serve as a tremendous educational resource to residents; however, there are multiple barriers to an effective resident-fellow teaching interaction in the setting of inpatient consultation. We designed and evaluated a resident-directed intervention to enhance communication and teaching during consultation on the general medicine wards.
Five medical teams were randomized to receive the intervention over a 3 month period (3 control, 2 intervention teams). The intervention was evaluated with pre and post-intervention surveys.
Fifty-nine of 112 interns completed the pre-intervention survey, and 58 completed the post-intervention survey (53 % response rate). At baseline, 83 % of the interns noted that they had in-person interactions with fellows less than 50 % of the time. 81 % responded that they received teaching from fellows in less than 50 % of consultations. Following the intervention, the percentage of interns who had an in-person interaction with fellows greater than 50 % of the time increased in the intervention group (9 % control versus 30 % intervention, p = 0.05). Additionally, interns in the intervention group reported receiving teaching in more than 50 % of their interactions more frequently (19 % control versus 42 % intervention, p = 0.05). There were no differences in other measures of teaching and communication.
We demonstrate that a time-efficient intervention increased perceptions of in-person communication and the number of teaching interactions between interns and fellows. Further studies are warranted to determine whether such an approach can impact resident learning and improve patient care.
专科住院医师可为住院医师提供丰富的教育资源；然而，在住院会诊过程中，实现有效的住院医师-专科住院医师教学互动存在多重障碍。我们设计并评估了一项由住院医师主导的干预措施，以加强普通内科病房会诊期间的沟通与教学。
五个医疗团队在3个月的时间内被随机分组，接受干预措施（3个对照组，2个干预组）。通过干预前后的调查对干预措施进行评估。
112名实习医生中有59名完成了干预前调查，58名完成了干预后调查（回复率为53%）。在基线时，83%的实习医生指出，他们与专科住院医师进行面对面交流的时间不到50%。81%的人表示，他们在不到50%的会诊中接受专科住院医师的教学。干预后，干预组中与专科住院医师进行面对面交流时间超过50%的实习医生比例有所增加（对照组为9%，干预组为30%，p = 0.05）。此外，干预组的实习医生报告称，他们在超过50%的互动中更频繁地接受教学（对照组为19%，干预组为42%，p = 0.05）。在教学和沟通的其他指标方面没有差异。
我们证明，一项省时的干预措施提高了对面对面交流的认知以及实习医生与专科住院医师之间教学互动的次数。有必要进一步研究这种方法是否会影响住院医师的学习并改善患者护理。
