Levin Jonathan C, Hron Jonathan
J Grad Med Educ. 2017 Jun;9(3):361-365. doi: 10.4300/JGME-D-16-00469.1.
The Accreditation Council for Graduate Medical Education has called for increased emphasis on reporting objective performance measures to trainees and programs. However, reporting of objective measures, including clinical volume, is largely omitted from training programs.
To use automated electronic medical systems at a tertiary pediatric care hospital to create a dashboard that reports objective trainee and program metrics, including clinical volume and diagnoses in a pediatrics residency.
We queried an enterprise data warehouse that aggregates data daily from multiple hospital systems to identify patient encounters during which senior pediatrics residents at Boston Children's Hospital had entered documentation over a 9-month period. From this query, we created a filterable dashboard to display clinical volume and diagnosis data by individual resident and in aggregate.
A total of 44 of 45 senior residents (98%) in the program were included in analysis. We identified 12 198 patient encounters during which a senior pediatrics resident had entered documentation; these included a median of 332 inpatient encounters per resident, 122 emergency department encounters, and 84 outpatient encounters. The most common diagnoses stratified by clinical site were: inpatient - dehydration (median = 61); emergency department - long-term/current drug therapy (median = 16); and outpatient - encounter for immunization (median = 48).
We used electronic health record systems to generate performance dashboards for trainees in a pediatrics residency across different sites of care with reported volume by diagnosis. Our dashboards provide feedback to program leadership regarding individual and aggregate trainee experience and allow individual trainees to compare their clinical exposure to peers.
毕业后医学教育认证委员会呼吁更加重视向实习生和培训项目报告客观绩效指标。然而，培训项目很大程度上忽略了包括临床量在内的客观指标的报告。
利用一家三级儿科护理医院的自动化电子医疗系统创建一个仪表板，报告客观的实习生和项目指标，包括儿科住院医师培训中的临床量和诊断情况。
我们查询了一个企业数据仓库，该仓库每天汇总来自多个医院系统的数据，以确定波士顿儿童医院的高级儿科住院医师在9个月期间录入文档的患者诊疗情况。通过此查询，我们创建了一个可筛选的仪表板，以按个体住院医师和总体显示临床量和诊断数据。
该项目45名高级住院医师中有44名（98%）纳入分析。我们确定了12198次患者诊疗，期间有高级儿科住院医师录入了文档；其中每位住院医师平均有332次住院诊疗、122次急诊科诊疗和84次门诊诊疗。按临床科室分层的最常见诊断为：住院部——脱水（中位数=61）；急诊科——长期/当前药物治疗（中位数=16）；门诊部——免疫接种诊疗（中位数=48）。
我们使用电子健康记录系统为儿科住院医师培训中的实习生生成不同护理场所的绩效仪表板，并按诊断报告诊疗量。我们的仪表板向项目负责人提供有关个体和总体实习生经验的反馈，并允许个体实习生将自己的临床接触情况与同行进行比较。
