Le Comte Lyndsay, Hayward Brooke, Hughes David, Villa Luis, Madell Dominic
Ko Awatea, Counties Manukau Health, New Zealand.
J Prim Health Care. 2016 Dec;8(4):288-294. doi: 10.1071/HC16001.
BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300-600 patients in one practice and 800-1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.
背景 新西兰医学委员会要求到2020年，即将毕业的医生在其执业的头两年内要有社区实习经历。曼努考郡医疗服务机构制定了一项计划，住院医师（HOs）会在一家全科诊所实习三个月。
目的 本研究旨在确定在曼努考郡进行四次住院医师全科实习的价值，并描述这些住院医师在这些诊所中的使用情况。
方法 采用混合方法设计来评估三次实习情况。两家诊所提供了住院医师诊治的患者数量。对58名患者进行了调查，以评估患者对住院医师的看法。六名住院医师、四名指导全科医生、两名初级卫生组织高级工作人员和一名诊所经理参加了半结构化访谈。在所有四家诊所与护士、医生和行政人员举行了焦点小组讨论。
结果 住院医师在一家诊所实习期间诊治了300 - 600名患者，在另一家诊所诊治了800 - 1000名患者。各诊所制定了自己指导和教导住院医师的方法。大多数患者对住院医师给予了积极评价。访谈和焦点小组讨论得出的主题在参与者中是一致的，包括：住院医师的信心增强、临床技能提高以及对全科医疗的理解加深；诊所的额外能力以及医疗质量和员工满意度的提高。
结论 住院医师和诊所对住院医师在全科诊所的实习给予了积极评价。住院医师培养了临床技能并加深了对初级卫生保健的理解。诊所团队在为确保高质量患者护理提供临床支持的同时，也享受到了住院医师的活力和热情。
