Ann Arbor Veterans Affairs Center for Clinical Management Research, USA; University of Michigan Medical School, Department of Medicine & Learning Health Sciences, Ann Arbor, USA.
University of Colorado School of Medicine, Department of Medicine, Aurora, USA.
Patient Educ Couns. 2018 Mar;101(3):475-480. doi: 10.1016/j.pec.2017.09.001. Epub 2017 Sep 8.
The Do No Harm Project is a novel reflective writing program that encourages medical trainees to reflect on and write up clinical narratives about instances of avoidable medical overuse. Our goal is to describe this program and to explore the effect of the program on those participating.
Semi-structured interviews were conducted to explore how participating in the project influenced the thinking, attitudes, and behaviors of participating internal medicine residents. Interviews were conducted with 20 out of the 24 participants from the first 15 months of the program.
The following themes emerged from our analysis: 1) learning through reflection (with three sub-themes: empathy for the patient perspective, a critical approach to one's own clinical practice, and awareness of the problem of overuse); 2) empowerment to discuss instances of overuse and act before it occurs; and 3) perceptions of enhanced evidence-based practice and shared decision-making.
Trainees volunteering to complete a reflective writing exercise perceived improved ability to avoid overuse and improved self-efficacy to change clinical behaviors that do not align with optimal patient care.
Reflective writing may help trainees recognize and avoid medical overuse.
“不造成伤害项目”是一个新颖的反思性写作项目，鼓励医学受训者反思并撰写关于可避免的过度医疗实例的临床叙事。我们的目标是描述该项目，并探讨该项目对参与项目的人员的影响。
采用半结构化访谈，探讨参与该项目如何影响参与的内科住院医师的思维、态度和行为。对该项目前 15 个月的 24 名参与者中的 20 名进行了访谈。
我们的分析得出以下主题：1）通过反思学习（有三个子主题：对患者视角的同理心、对自己临床实践的批判态度以及对过度使用问题的认识）；2）有能力讨论过度使用的情况，并在发生之前采取行动；3）对增强循证实践和共同决策的看法。
自愿完成反思性写作练习的受训者认为，他们能够更好地避免过度医疗，并提高改变不符合最佳患者护理的临床行为的自我效能感。
反思性写作可能有助于受训者识别和避免过度医疗。
