增加额外的医疗服务提供者对住院医师工作量及医疗会诊轮转期间住院医师体验的影响。
Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.
作者信息
Fang Michele, Linson Eric, Suneja Manish, Kuperman Ethan F
机构信息
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
BMC Med Educ. 2017 Feb 22;17(1):44. doi: 10.1186/s12909-017-0874-7.
BACKGROUND
Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation.
METHODS
In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013.
RESULTS
The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p < 0.001) and 5.7(SD 2.0) in FY2015 (p < 0.001). A higher proportion of residents reported "just right" patient volume (64.4%, 91.7%, 96.7% in FY2013, 2014, 2015 respectively p < 0.001), meeting curricular goals (79.9%, 95.0%, 97.2%, in FY2013, 2014 and 2015 respectively p < 0.001), and overall educational value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p < 0.001).
CONCLUSIONS
Decreasing resident workload through adding clinical faculty (both staff physician and APPs) was associated with improvements on resident perceived educational value and clinical experience of a medical consultation rotation.
背景
研究生医学教育的卓越需要合适的临床环境和适当的工作量，使住院医师有足够的患者来熟练掌握医学知识，并拥有最佳的反思时间。研究生医学教育认证委员会（ACGME）更多地关注工作时长而非工作量；然而，住院医师高工作量与住院医师参与教育的程度较低以及与疲劳相关的错误有关。认识到与住院医师高工作量相关的潜在风险，并考虑到减少住院医师工作量的成本，我们试图通过在外科共同管理服务（SCM）中增加一名高级实践提供者（APP）来减少住院医师的工作量，并研究其对住院医师满意度和该轮转的感知教育价值的影响。
方法
在2014财年和2015财年，SCM轮转增加了一名教员。2014财年，该教员是一名在职医师，2015财年，该教员是一名APP。使用计费数据评估住院医师的工作量。我们使用匿名电子调查工具测量住院医师对该轮转的看法。我们将2014 - 2015财年的数据与2013财年的基线数据进行比较。
结果
每位住院医师每天诊治的患者数量从2013财年的8.0（标准差3.3）降至2014财年的5.0（标准差1.9）（p < 0.001）和2015财年的5.7（标准差2.0）（p < 0.001）。报告患者数量“恰到好处”的住院医师比例更高（2013财年、2014财年、2015财年分别为64.4%、91.7%、96.7%，p < 0.001），达到课程目标的比例（2013财年、2014财年、2015财年分别为79.9%、95.0%、97.2%，p < 0.001），以及该轮转的整体教育价值（2013财年、2014财年、2015财年分别为40.0%、72.2%、72.6%，p < 0.001）。
结论
通过增加临床教员（在职医师和APP）来减少住院医师工作量，与住院医师感知的教育价值和医疗会诊轮转的临床经验的改善相关。
Zotero 插件