Lin Doris, Shah Chirayu, Campbell Steffanie, Bates Jeffrey T, Lescinskas Erica
From the Department of Medicine, Baylor College of Medicine, Ben Taub Hospital, Houston, Texas, and the Michael E. DeBakey Veterans Affairs Medical Center, Medical Care Line, Houston, Texas.
South Med J. 2018 Jan;111(1):30-34. doi: 10.14423/SMJ.0000000000000751.
The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience.
This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey. Primary outcomes included confidence in managing hospitalized patients, knowledge regarding hospital medicine topics, and interest in pursuing hospital medicine as a career.
Thirty-three PGY-2 residents completed both the pre- and postrotation survey (72% response rate). After completing the rotation, the residents' confidence level (measured on a 5-point Likert scale, with 1 = strongly disagree and 5 = strongly agree) rose significantly in managing hospitalized patients, from 3.82 to 4.33 ( = 0.003) and in leading a ward team, from 3.76 to 4.21 ( = 0.020). Knowledge level (measured on a 5-point Likert scale with 1 = very poor and 5 = excellent) improved significantly in transitions of care, from 3.45 to 3.79 ( = 0.023); cost-conscious care, from 3.00 to 3.42 ( = 0.016); physician billing/coding, from 2.55 to 3.03 ( = 0.007); hospital metrics, from 2.39 to 2.94 ( = 0.002); and hospital reimbursement, from 2.48 to 3.09 ( = 0.001). Interest in pursuing hospital medicine as a career also increased.
Resident independence in managing patients and training in hospital medicine topics has not kept up with evolving need. Dedicated hospital medicine rotation and curriculum are effective ways to alleviate the deficiencies in resident education.
本研究的目的是通过一项名为“住院医师培训体验”的新开发轮转计划和课程，提高住院医师对住院患者护理的信心以及在医院医学主题方面的知识。
本研究是一项前瞻性观察性研究，由两家附属医院的二年级内科住院医师完成。46名二年级住院医师每人在“住院医师培训体验”服务轮转1个月，并在轮转前后完成一份保密的在线调查。主要结果包括管理住院患者的信心、关于医院医学主题的知识以及将医院医学作为职业追求的兴趣。
33名二年级住院医师完成了轮转前后的调查（回复率为72%）。完成轮转后，住院医师在管理住院患者方面的信心水平（采用5分制李克特量表测量，1 = 强烈不同意，5 = 强烈同意）显著提高，从3.82升至4.33（P = 0.003），在领导病房团队方面，从3.76升至4.21（P = 0.020）。知识水平（采用5分制李克特量表测量，1 = 非常差，5 = 优秀）在护理过渡方面显著提高，从3.45升至3.79（P = 0.023）；在成本意识护理方面，从3.00升至3.42（P = 0.016）；在医生计费/编码方面，从2.55升至3.03（P = 0.007）；在医院指标方面，从2.39升至2.94（P = 0.002）；在医院报销方面，从2.48升至3.09（P = 0.001）。将医院医学作为职业追求的兴趣也有所增加。
住院医师在管理患者方面的独立性以及在医院医学主题方面的培训未能跟上不断变化的需求。专门的医院医学轮转计划和课程是缓解住院医师教育不足的有效方法。
