Ross Paula T, Fitzgerald James T, Ravindranath Divy, Pfeiffer Paul N, Singh Mamta K, Weiner Saul J, Rooney Deborah M, Buckler Stacie, Whitman Laurie, Watts Brook, Jones Dorian, Tremblay Adam S, Lypson Monica L
J Grad Med Educ. 2018 Jun;10(3):279-284. doi: 10.4300/JGME-D-17-00700.1.
Despite their placement in Veterans Health Administration centers nationwide, residents' training and assessment in veteran-centered care is variable and often insufficient.
We assessed residents' ability to recognize and address mental health issues that affect US military veterans.
Two unannounced standardized patient (SP) cases were used to assess internal medicine residents' veteran-centered care skills from September 2014 to March 2016. Residents were assessed on 7 domains: military history taking, communication skills, assessment skills, mental health screening, triage, and professionalism, using a 36-item checklist. After each encounter, residents completed a questionnaire to assess their ability to recognize knowledge deficits. Residents' mean scores were compared across training levels, between the 2 cases, and by SP gender. We conducted analysis of variance (ANOVA) tests to analyze mean performance differences across training levels and descriptive statistics to analyze self-assessment questionnaire results.
Ninety-eight residents from 2 internal medicine programs completed the encounter and 53 completed the self-assessment questionnaire. Residents performed best on professionalism (0.92 ± 0.20, percentage of the maximal score) and triage (0.87 ± 0.17), and they scored lowest on posttraumatic stress disorder (0.52 ± 0.30) and military sexual trauma (0.33 ± 0.39). Few residents reported that they sought out training to enhance their knowledge and skills in the provision of services and support to military and veteran groups beyond their core curriculum.
This study suggests that additional education and assessment in veteran-centered care may be needed, particularly in the areas of posttraumatic stress disorder and military sexual trauma.
尽管在全国退伍军人健康管理局中心开展了住院医师培训，但以退伍军人为中心的护理方面的住院医师培训和评估参差不齐，且往往不足。
我们评估了住院医师识别和处理影响美国退伍军人心理健康问题的能力。
2014年9月至2016年3月，使用两个未事先通知的标准化患者（SP）病例来评估内科住院医师以退伍军人为中心的护理技能。使用一份包含36个条目的清单，从7个领域对住院医师进行评估：军事史采集、沟通技巧、评估技能、心理健康筛查、分诊和职业素养。每次问诊后，住院医师完成一份问卷，以评估他们识别知识缺陷的能力。比较了不同培训水平、两个病例之间以及SP性别的住院医师平均得分。我们进行方差分析（ANOVA）测试以分析不同培训水平之间的平均表现差异，并进行描述性统计以分析自我评估问卷结果。
来自两个内科项目的98名住院医师完成了问诊，53名完成了自我评估问卷。住院医师在职业素养（0.92±0.20，满分百分比）和分诊（0.87±0.17）方面表现最佳，在创伤后应激障碍（0.52±0.30）和军事性创伤（0.33±0.39）方面得分最低。很少有住院医师报告说他们寻求培训以增强在为军事和退伍军人团体提供服务和支持方面的知识和技能，超出其核心课程范围。
本研究表明，可能需要在以退伍军人为中心的护理方面进行更多教育和评估，特别是在创伤后应激障碍和军事性创伤领域。
