Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
Med Educ. 2017 May;51(5):480-489. doi: 10.1111/medu.13276.
There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume.
This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes.
This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed.
After adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality.
Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning.
一些研究表明，当医生的实践量较大时，患者的预后会更好，而另一些研究则发现，随着培训后时间的增加，结果会更差，这意味着实践量更大。这两者之间似乎存在矛盾。
本研究旨在估计医生特征（包括近期实践量和医学院毕业后时间）与患者预后之间的调整关系。
这是一项基于宾夕法尼亚州 7 年来所有急性心肌梗死、充血性心力衰竭、胃肠道出血、髋部骨折和肺炎住院患者的回顾性观察性研究。它涉及 184 家医院的 694020 例住院患者，由 5280 名内科医生和家庭医生就诊。分析了患者入院时的严重程度和院内死亡率、医院位置和容量，以及医生最近的实践量、医学院毕业后时间、董事会认证以及公民身份或医学院所在地。
调整后，最近的实践量与所有合并病症的院内死亡率没有统计学上的显著关联。相比之下，医学院毕业后的每十年都会使患者死亡的相对风险增加 4.5%。
最近的实践量并不能减轻与医生医学院毕业后时间相关的患者死亡率的增加。这些发现强调了寻找支持和鼓励学习的方法的必要性。
