Wigton R S, Blank L L, Nicolas J A, Tape T G
University of Nebraska College of Medicine, Omaha.
Ann Intern Med. 1989 Dec 1;111(11):932-8. doi: 10.7326/0003-4819-111-11-932.
To obtain the opinions of internal medicine residency program directors about which procedural skills residents master during training and the amount of training needed to attain and maintain competence in each procedure.
A mailed survey to all program directors in the United States.
Program directors or their designees from 389 of 431 (90%) internal medicine residency programs.
For several procedures, 40% more respondents said all residents should master the procedure than said all their residents do master the procedure. Some procedures commonly done in practice were perceived as mastered by all residents in fewer than half of the programs. There were few differences in procedures learned by size or type of program. A fellowship program did affect exposure to some procedures in the field covered by the program. Median recommendations of training needed to master each procedure were similar to those of practicing internists for most procedures.
Current residency training does not assure competency in all of the procedures the general internist does in practice. Program directors should examine which skills are adequately taught, test competence, and ways to improve residents' skills. Practicing general internists should have access to supervised training in procedural skills.
获取内科住院医师培训项目主任对于住院医师在培训期间掌握哪些操作技能以及掌握并维持每项操作技能所需培训量的看法。
向美国所有项目主任邮寄调查问卷。
431个内科住院医师培训项目中389个项目（90%）的项目主任或其指定代表。
对于多项操作，认为所有住院医师都应掌握该操作的受访者比认为其所有住院医师都已掌握该操作的受访者多40%。一些在实际操作中常见的操作，在不到半数的项目中被认为所有住院医师都已掌握。项目的规模或类型在所学操作方面差异不大。专科培训项目确实会影响在该项目所涵盖领域内接触某些操作的机会。对于大多数操作，掌握每项操作所需培训的中位数建议与执业内科医师的建议相似。
当前的住院医师培训并不能确保普通内科医师在实际操作中的所有技能都达到胜任水平。项目主任应检查哪些技能得到了充分传授、测试能力以及提高住院医师技能的方法。执业普通内科医师应能获得操作技能的监督培训。
