Zastoupil Laura, McIntosh Amanda, Sopfe Jenna, Burrows Jason, Kraynik Jessica, Lane Lindsey, Hanson Janice, Seltz L Barry
Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
Acad Pediatr. 2017 May-Jun;17(4):436-442. doi: 10.1016/j.acap.2017.01.009. Epub 2017 Jan 24.
To evaluate the impact of transitioning from noon conference (NC) to academic half day (AHD) on conference attendance, interruptions, and perceived protected educational time and to describe pediatric resident experiences with AHD.
In this mixed-methods study, data before and after AHD implementation were collected. Quantitative data were analyzed with a 2-variable t test or chi-square test. Five focus groups and 5 individual interviews of pediatric residents were conducted. Data were analyzed using constant comparative methods, and were collected until reaching saturation. In accordance with grounded theory methodology, we developed codes using an iterative approach and identified major themes.
After AHD implementation, resident attendance increased from 55% (of residents expected at NC) to 94% (of residents scheduled for AHD) (P < .001); interruptions decreased from 0.25 to 0.01 per resident per hour (P < .001). Positive responses regarding perceived protected educational time improved from 50% to 95% (2015 class) and from 19% to 50% (2016 class) (P < .001). Thirty-two residents participated in focus groups and interviews. Analysis yielded 5 themes: aids and barriers to AHD attendance; teaching; curricular content; learning and engagement; and resident well-being. Residents felt aided attending AHD when clinical supervisors supported their educational time. Compared to NC, residents noted better topic selection but fewer covered topics. Residents valued protected educational time without clinical responsibilities and thought that small-group discussions at AHD facilitated learning. Although cross-covering was stressful, AHD positively contributed to resident well-being.
AHD improves resident attendance, interruptions, and perceived learning, and it contributes to resident wellness. More work is needed to mitigate the workload of cross-covering residents.
评估从午间会议（NC）过渡到学术半天（AHD）对会议出席率、干扰情况以及感知到的受保护教育时间的影响，并描述儿科住院医师对AHD的体验。
在这项混合方法研究中，收集了实施AHD前后的数据。定量数据采用双变量t检验或卡方检验进行分析。对儿科住院医师进行了5个焦点小组和5次个人访谈。数据采用持续比较法进行分析，直至达到饱和状态。根据扎根理论方法，我们采用迭代方法制定编码并确定主要主题。
实施AHD后，住院医师的出席率从NC预期的住院医师的55%提高到AHD安排的住院医师的94%（P <.001）；干扰从每位住院医师每小时0.25次降至0.01次（P <.001）。对感知到的受保护教育时间的积极反馈从2015级的50%提高到95%，从2016级的19%提高到50%（P <.001）。32名住院医师参加了焦点小组和访谈。分析得出5个主题：AHD出席的辅助因素和障碍；教学；课程内容；学习与参与；以及住院医师的幸福感。当临床主管支持他们的教育时间时，住院医师觉得参加AHD有帮助。与NC相比，住院医师指出主题选择更好，但涵盖的主题更少。住院医师重视没有临床职责的受保护教育时间，并认为AHD的小组讨论促进了学习。尽管交叉值班压力很大，但AHD对住院医师的幸福感有积极贡献。
AHD提高了住院医师的出席率、减少了干扰并提升了感知到的学习效果，且有助于住院医师的健康。需要开展更多工作来减轻交叉值班住院医师的工作量。
