Guy's and St Thomas' NHS Foundation Trust, London, UK.
Kings College London, UK.
Anaesthesia. 2018 Nov;73(11):1392-1399. doi: 10.1111/anae.14410. Epub 2018 Aug 27.
We established an innovative Foundation placement in peri-operative medicine for older patients in response to the need for training in 'whole patient' medicine and the challenge of fewer Foundation doctors in acute surgical roles. The placement and underpinning curriculum were co-designed with junior doctors and other clinical stakeholders. This resulted in a modular design offering acute and community experience and dedicated quality improvement project time. To evaluate the placement we used a mixed methods study based on Kirkpatrick's model of workplace learning. Level 1 (trainee reaction) was evaluated using Job Evaluation Study Tool questionnaires and nominal group technique. Levels 2 and 3 (trainee learning/behaviour) were assessed using a Likert-style survey mapped to curriculum objectives, e-portfolio completion, nominal group technique and documentation of completed quality improvement projects and oral/poster presentations. Sixty-eight foundation trainees underwent the new placement. A similar-sized 'control' sample (n = 57) of surgical Foundation trainees within the same Trust was recruited. The trainees in the peri-operative placement attained both generic Foundation and specific peri-operative curriculum competencies, and gave higher job satisfaction scores than trainees in standard surgical placements. The top three ranked advantages from the nominal group sessions were senior support, clinical variety and project opportunities. Universal project completion resulted in high rates of poster and platform presentations, and in sustained service changes at hospital level.
我们针对“整体患者”医学培训的需求以及急性外科角色中初级医生人数减少的挑战，为老年患者设立了一个创新性的围手术期医学基础培训项目。该培训项目及基础课程由初级医生和其他临床利益相关者共同设计。这导致了一个模块化设计，提供了急性和社区经验以及专门的质量改进项目时间。为了评估该培训项目，我们使用了基于 Kirkpatrick 工作场所学习模型的混合方法研究。第 1 级（学员反应）使用工作评估研究工具问卷和名义小组技术进行评估。第 2 级和第 3 级（学员学习/行为）使用与课程目标、电子档案完成情况、名义小组技术以及已完成质量改进项目和口头/海报演示文档相关的李克特式调查进行评估。68 名基础培训生接受了新的培训项目。在同一信托基金中，还招募了一个类似规模的“对照组”（n=57）外科基础培训生。接受围手术期培训的培训生既获得了通用的基础培训和特定的围手术期课程能力，又比接受标准外科培训的培训生获得了更高的工作满意度评分。从名义小组会议中排名前三的优势是高级支持、临床多样性和项目机会。普遍完成项目导致了高比例的海报和平台演示，以及在医院层面上持续的服务变更。
