Fetters Michael D, Motohara Satoko, Ivey Lauren, Narumoto Keiichiro, Sano Kiyoshi, Terada Masahiko, Tsuda Tsukasa, Inoue Machiko
Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA.
School of Medicine, Loma Linda University, Loma Linda, CA USA.
Asia Pac Fam Med. 2017 Jan 10;16:1. doi: 10.1186/s12930-016-0031-1. eCollection 2017.
Family medicine education-emerging countries face challenges in demonstrating a new program's ability to train residents in womb-to-tomb care and resident ability to provide such care competently. We illustrate the experience of a new Japanese family medicine program with resident self-competency assessments.
In this longitudinal cross-sectional study, residents completed self-competency assessment surveys online during 2011-2015. Each year of training, residents self-ranked their competence using a 100-point visual analog scale for 142 conditions: acute (30 conditions), chronic (28 conditions) women's health (eight conditions), and geriatrics/home (12 conditions) care; procedures (38 types); health promotion (21 conditions).
Twenty residents (11 women, 9 men) participated. Scores improved annually by training year from baseline to graduation; the mean composite score advanced from 31 to 65%. All subcategories showed improvement. Scores for care involving acute conditions rose from 49 to 75% (26% increase); emergency procedures, 46-65% (19% increase); chronic care, 33-73% (40% increase); women's health, 16-59% (43% increase); procedural care, 26-56% (30% increase); geriatrics care-procedures, 8-65% (57% increase); health promotion, 21-63% (42% increase). Acute care, chronic care, and health promotion achieved the highest levels. Women's health care, screenings, and geriatrics experienced the greatest increase. Health promotion gains occurred most dramatically in the final residency year.
A resident self-competency assessment provides a simple and practical way to conduct an assessment of skills, to monitor skills over time, to use the data to inform residency program improvement, and to demonstrate the breadth of family medicine training to policymakers, and other stakeholders.
在新兴国家，家庭医学教育面临诸多挑战，即证明新的项目有能力培养能提供从出生到死亡全程护理的住院医师，以及住院医师具备胜任此类护理的能力。我们阐述了一个日本新家庭医学项目在住院医师自我能力评估方面的经验。
在这项纵向横断面研究中，住院医师于2011年至2015年期间在线完成自我能力评估调查。在培训的每一年，住院医师使用100分视觉模拟量表对142种情况进行自我能力排名：急性病（30种情况）、慢性病（28种情况）、女性健康（8种情况）以及老年病/家庭护理（12种情况）；操作技能（38种类型）；健康促进（21种情况）。
20名住院医师（11名女性，9名男性）参与了研究。从基线到毕业，每年的培训使分数都有所提高；综合平均分数从31%提高到了65%。所有子类别都有改善。涉及急性病护理的分数从49%提高到75%（提高了26%）；急诊操作技能，从46%提高到65%（提高了19%）；慢性病护理，从33%提高到73%（提高了40%）；女性健康护理，从16%提高到59%（提高了43%）；操作护理，从26%提高到56%（提高了30%）；老年病护理操作技能，从8%提高到65%（提高了57%）；健康促进，从21%提高到63%（提高了42%）。急性病护理、慢性病护理和健康促进达到了最高水平。女性健康护理、筛查以及老年病护理的分数增长最为显著。健康促进方面的分数增长在住院医师培训的最后一年最为明显。
住院医师自我能力评估提供了一种简单实用的方法，可用于进行技能评估、长期监测技能、利用数据改进住院医师培训项目，并向政策制定者和其他利益相关者展示家庭医学培训的广度。
