Weeks Matthew, Cole Brandon, Flake Eric, Roy Daniel
Department of Pediatrics, Madigan Army Medical Center, 9040 Fitzsimmons Ave, Tacoma, WA.
Mil Med. 2018 Nov 1;183(11-12):e676-e679. doi: 10.1093/milmed/usy057.
This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care.
Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training.
Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3.
The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.
本研究旨在描述当前住院医师和经验丰富的儿科医生对将患有复杂疾病的患者转诊至成人护理的毕业后医学教育的数量和满意度。将患有复杂疾病的青少年转诊至成人护理的需求日益增加。现在超过90%的此类青少年活到成年,需要转诊至成人医疗服务提供者处。2010年全国特殊医疗需求儿童调查发现,12至17岁的青少年中只有40%获得了适当转诊至成人护理所需的必要服务。
2017年3月,对陆军儿科住院医师培训项目的儿科住院医师和儿科 staff 医生进行了一项前瞻性、描述性、匿名的基于网络的调查。问题集中在评估护理转诊知识、对转诊培训的满意度以及毕业后医学教育培训期间接受的转诊教育量。
在145名受访者中(310名潜在受访者,回复率47%),转诊被认为很重要,评分为4.3(满分5分)。转诊的舒适度评分为2.6(满分5分),住院期间只有4.2%的参与者接受过正规教育。实施课程最常被认为的障碍是时间限制和可用资源。在五个知识评估问题中,有三个的正确回答率不到三分之一。
研究结果显示了在将患有复杂疾病的儿科患者转诊至成人护理的正规课程的存在与感知需求之间的差距。本研究还凸显了新手和经验丰富的儿科医生在转诊过程中的知识差距。