Kelly Martina, Everard Kelly M, Nixon Lara, Chessman Alexander
Cumming School of Medicine, University of Calgary, Canada.
Fam Med. 2017 Jun;49(6):437-442.
While family medicine residency directors have expressed concern about low procedural skills proficiency among incoming residents, curricular recommendations do not provide widely accepted guidance. This study was designed to describe requirements and experiences in procedural skill training during the family medicine clerkship and test the hypothesis that more rural placements may support this training.
The survey was conducted as part of the CAFM Educational Research Alliance (CERA) Family Medicine Clerkship Director (CD) 2013 survey. All Liaison Committee on Medical Education (LCME)-accredited medical schools in the US and Canada with a family medicine educator as family medicine or primary care CD were surveyed. CDs answered questions about clerkship structure and procedure experience and requirements for students. Choosing from a list of procedures, respondents detailed how often students perform specific skills during a rotation.
The response rate was 73% (94 out of 129). Thirty-six procedures were performed during the family medicine clerkship. Of the procedures performed at least once, the most common were Pap test (57.1%), vaginal swab (42.9%), ECG recording (41.9%), urinalysis (40.0%), and throat swab (39.0%). Of the procedures performed more than three times, the most common were Pap test (21.0%) and sterile technique (20.0%). Learners in rural rotations were more likely to perform a range of procedures.
Though exposed to a wide range of procedures during the family medicine clerkship, students did not often repeat procedures. Creation of a core list of procedures and taking better advantage of rural placements may improve procedural skill training in the family medicine clerkship.
虽然家庭医学住院医师培训项目主任对新入职住院医师的操作技能熟练度较低表示担忧，但课程建议并未提供广泛认可的指导。本研究旨在描述家庭医学实习期间操作技能培训的要求和经验，并检验更多农村实习点可能支持这种培训的假设。
该调查是作为加拿大家庭医学教育研究联盟（CERA）2013年家庭医学实习主任（CD）调查的一部分进行的。对美国和加拿大所有经医学教育联络委员会（LCME）认证、有家庭医学教育工作者担任家庭医学或初级保健CD的医学院校进行了调查。CD们回答了有关实习结构、操作经验以及学生要求的问题。从一系列操作中进行选择，受访者详细说明了学生在轮转期间执行特定技能的频率。
回复率为73%（129份中的94份）。家庭医学实习期间共进行了36项操作。在至少进行过一次的操作中，最常见的是巴氏试验（57.1%）、阴道拭子检查（42.9%）、心电图记录（41.9%）、尿液分析（40.0%）和咽拭子检查（39.0%）。在进行超过三次的操作中，最常见的是巴氏试验（21.0%）和无菌技术（20.0%）。农村轮转的学习者更有可能进行一系列操作。
虽然在家庭医学实习期间接触了广泛的操作，但学生并不经常重复这些操作。制定一份核心操作清单并更好地利用农村实习点可能会改善家庭医学实习中的操作技能培训。
