Sobel Halle G, Swigris Rachel, Chacko Karen M, Landrey Alison, McNulty Monica, Vennard Kaitlyn, Nikels Susan Michelle, Suddarth Kathleen, Murphy Edward N, Aagaard Eva
J Grad Med Educ. 2017 Aug;9(4):497-502. doi: 10.4300/JGME-D-16-00609.1.
Some internal medicine residency programs on X+Y schedules have modified clinic preceptor schedules to mimic those of the resident cohort (resident matched). This is in contrast to a traditional model, in which preceptors supervise on the same half-day each week.
We assessed preceptor and resident perceptions of the 2 precepting models.
We surveyed 44 preceptors and 97 residents at 3 clinic sites in 2 academic medical centers. Two clinics used the resident-matched model, and 1 used a traditional model. Surveys were completed at 6 months and 1 year. We assessed resident and preceptor perceptions in 5 domains: relationships between residents and preceptors; preceptor familiarity with complex patients; preceptor ability to assess milestone achievements; ability to follow up on results; and quality of care.
There was no difference in perceptions of interpersonal relationships or satisfaction with patient care. Preceptors in the resident-matched schedule reported they were more familiar with complex patients at both 6 months and 1 year, and felt more comfortable evaluating residents' milestone achievements at 6 months, but not at 1 year. At 1 year, residents in the resident-matched model perceived preceptors were more familiar with complex patients than residents in the traditional model. The ability to discuss patient results between clinic weeks was low in both models.
The resident-matched model increased resident and preceptor perceptions of familiarity with complex patients and early preceptor perceptions of comfort in assessment of milestone achievements.
一些采用X+Y排班制的内科住院医师培训项目调整了门诊带教老师的排班，以模仿住院医师群体的排班（住院医师匹配）。这与传统模式不同，在传统模式中，带教老师每周在同一个半天进行指导。
我们评估了带教老师和住院医师对这两种带教模式的看法。
我们对2个学术医疗中心的3个门诊地点的44名带教老师和97名住院医师进行了调查。2个门诊采用住院医师匹配模式，1个采用传统模式。在6个月和1年时完成调查。我们在5个领域评估了住院医师和带教老师的看法：住院医师与带教老师之间的关系；带教老师对复杂患者的熟悉程度；带教老师评估里程碑式成就的能力；跟进结果的能力；以及护理质量。
在人际关系看法或对患者护理的满意度方面没有差异。采用住院医师匹配排班的带教老师报告说，在6个月和1年时他们对复杂患者更熟悉，并且在6个月时对评估住院医师的里程碑式成就感觉更自在，但在1年时并非如此。在1年时，采用住院医师匹配模式的住院医师认为带教老师比采用传统模式的住院医师对复杂患者更熟悉。在两种模式中，门诊周之间讨论患者结果的能力都很低。
住院医师匹配模式提高了住院医师和带教老师对复杂患者的熟悉感，以及带教老师早期对评估里程碑式成就的自在感。
