Bullock Alison, Webb Katie Louise, Muddiman Esther, MacDonald Janet, Allery Lynne, Pugsley Lesley
School of Social Sciences, Cardiff Univeristy, Cardiff, UK.
School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, UK.
BMJ Open. 2018 Apr 12;8(4):e021388. doi: 10.1136/bmjopen-2017-021388.
Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service.
We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9).
From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees' ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients' psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated.
Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service.
患者人口结构的变化使得维持医疗服务的质量和安全变得愈发具有挑战性。解决这一问题的一种方法是为全科医生开展培训，使其能够采用更全面的医疗方式。我们在此报告的这项工作的目的是探讨一项基础广泛的培训计划能否让医生为不断变化的医疗服务做好准备。
我们采用了纵向混合方法，收集了英格兰基础广泛培训（BBT）项目学员（基线时n = 62）以及同一地区对照学员（基线时n = 90）的问卷调查数据。我们与BBT学员进行了15次焦点小组讨论，并对完成BBT培训后的学员（n = 21）及其教育督导（n = 9）进行了一对一电话访谈。
从问卷调查数据来看，与对照组相比，BBT学员更有信心认为他们的培训将带来以下结果：更广阔的视野、理解专科互补性、跨专科应用所学知识的能力、管理复杂患者以及提供以患者为中心的医疗服务。访谈和焦点小组的数据证明了BBT学员将其他专科知识应用于患者护理所带来的积极影响。具体而言，BBT带来的见解使学员能够调整转诊并考虑患者的心理和身体需求，从而采用更全面的医疗方式。焦点小组揭示了一些意外后果，即BBT学员表达了孤立感。然而，当我们在问卷调查中探究这种情绪时，我们发现对照组中至少同样多的人有时也会感到孤立。
了解跨专科医疗服务的从业者能够改善患者护理，并降低因专科间沟通不畅带来的风险。在国际上，人们越来越认识到全科医疗在医疗实践中的地位以及采取更以人为本方法的必要性。基础广泛的培训方法有助于培养全科医生，这非常适合不断变化的医疗服务。
