King Christopher J, Bolton Andrew, Guerrasio Jeannette, Trosterman Adam
From the Department of Medicine, University of Colorado School of Medicine, Aurora, CO, and the School of Medicine, Eastern Virginia Medical School, Norfolk, VA.
South Med J. 2017 Dec;110(12):765-769. doi: 10.14423/SMJ.0000000000000738.
Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school.
We developed a mixed-methods survey that was delivered to representatives of 82 schools via an e-mail link to an online survey.
Our response rate was 54% (44/82). Of those responding, 28% reported that students do not write any patient care orders at their institution and 34% reported not receiving pages related to patient care. Only 26% of institutions provide an increased patient load to students during their final year of training. Students identified many areas to improve the role of fourth-year medical students, including writing patient care orders, answering pages, increasing autonomy, defining their role better, and providing them with a longer subinternship experience.
Our survey suggests that students are graduating from the undergraduate medical education system and moving to the graduate medical education system in the United States without a guarantee of having answered a page related to patient care or having placed a patient care order. Further studies of students' experiences should be conducted to explore whether exposure to these skills improves first-year resident performance.
项目主任指出，一年级住院医师在进入美国毕业后医学教育系统时，在承担的许多患者护理职责方面存在困难。此前尚未发表过关于医学生毕业前患者护理经历的全国性描述。我们试图通过对每所学校的学生代表进行调查，来描述美国医学生在临床培训期间的经历。
我们开发了一项混合方法的调查，通过电子邮件链接将在线调查发送给82所学校的代表。
我们的回复率为54%（44/82）。在回复者中，28%报告称学生在其所在机构不书写任何患者护理医嘱，34%报告未收到与患者护理相关的传呼。只有26%的机构在学生培训的最后一年增加其患者护理量。学生们指出了许多可改进四年级医学生角色的方面，包括书写患者护理医嘱、接听传呼、增加自主权、更好地界定其角色以及为他们提供更长的实习前体验。
我们的调查表明，医学生从本科医学教育系统毕业并进入美国毕业后医学教育系统时，无法保证他们曾接听与患者护理相关的传呼或下达过患者护理医嘱。应进一步研究学生的经历，以探讨接触这些技能是否能提高一年级住院医师的表现。
