Klimas J, McNeil R, Ahamad K, Mead A, Rieb L, Cullen W, Wood E, Small W
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
BMC Med Educ. 2017 Jan 23;17(1):22. doi: 10.1186/s12909-017-0862-y.
Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting.
We interviewed physicians from the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital's academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick's model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10).
We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training.
Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.
尽管有大量可作为临床实践依据的证据，但大多数卫生系统并未将成瘾医学培训与医疗服务提供者的研究培训相结合。因此，成瘾护理往往缺乏，或者并非基于证据或最佳实践。我们进行了一项定性研究，以评估在医院环境中完成成瘾医学临床科学家培训项目的医生的经历。
我们采访了来自圣保罗医院戈德科普成瘾医学奖学金项目的医生以及加拿大温哥华该医院学术成瘾医学咨询团队的学员（N = 26）。他们包括精神科医生、内科和家庭医学医生、教员、导师、医学生和住院医生。所有人都接受了成瘾医学和研究培训。借鉴柯克帕特里克的培训项目评估模型，我们使用定性数据分析软件（Nvivo 10）对访谈进行了主题分析。
我们确定了与学习经历相关的五个有影响力的主题：（i）态度，（ii）知识，（iii）技能，（iv）行为和（v）患者结果。支持性的学习环境、时间安排的灵活性、高度结构化的轮转以及关于研究产品开发的明确指导促进了临床科学家培训。包括临床和家庭责任在内的相互竞争的优先事项阻碍了培训。
成瘾医学与研究的联合培训对在职医生和接受培训的医生来说是可行且可接受的。然而，仍有重要障碍需要克服，并且需要更好地了解成瘾医生在临床科学家轨道上的经历，以改进课程设置和研究生产力。
