Sclafani Alyssa, Currier Paul, Chang Yuchiao, Eromo Ersne, Raemer Daniel, Miloslavsky Eli M
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
J Hosp Med. 2019 Apr;14(4):218-223. doi: 10.12788/jhm.3168.
Internal Medicine (IM) residency graduates should be able to manage hospital emergencies, but the rare and critical nature of such events poses an educational challenge. IM residents' exposure to inpatient acute clinical events is currently unknown.
We developed an instrument to assess IM residents' exposure to and confidence in managing hospital acute clinical events.
We administered a survey to all IM residents at our institution assessing their exposure to and confidence in managing 50 inpatient acute clinical events. Exposures assessed included mannequin-based simulation or management of hospital-based events as a part of a team or independently in a leadership role. Confidence was rated on a five-point scale and dichotomized to "confident" versus "not confident." Results were analyzed by multivariable logistic regression to assess the relationship between exposure and confidence accounting for year in training.
A total of 140 of 170 IM residents (82%) responded. Postgraduate year 1 (PGY-1) residents had managed 31.3% of acute events independently vs 71.7% of events for PGY-3/4 residents (P < .0001). In multivariable analysis, residents' confidence increased with level of training (PGY-1 residents were confident to manage 24.9% of events vs 72.5% of events for PGY-3/4 residents, P < .0001) and level of exposure, independent of training year (P = .001). Events with the lowest levels of exposure and confidence for graduating residents were identified.
IM residents' confidence in managing inpatient acute events correlated with level of training and clinical exposure. We identified events with low levels of resident exposure and confidence that can serve as targets for future curriculum development.
内科住院医师培训毕业生应具备处理医院急症的能力，但此类事件的罕见性和严重性给教育带来了挑战。目前尚不清楚内科住院医师接触住院急性临床事件的情况。
我们开发了一种工具，以评估内科住院医师接触医院急性临床事件的情况以及处理这些事件的信心。
我们对本机构的所有内科住院医师进行了一项调查，评估他们接触50种住院急性临床事件的情况以及处理这些事件的信心。评估的接触情况包括基于人体模型的模拟，或作为团队一员处理医院事件，或以领导角色独立处理。信心采用五点量表评分，并分为“有信心”和“无信心”。通过多变量逻辑回归分析结果，以评估接触情况与信心之间的关系，并考虑培训年份的影响。
170名内科住院医师中有140名（82%）做出了回应。一年级住院医师（PGY-1）独立处理了31.3%的急性事件，而PGY-3/4住院医师处理了71.7%的事件（P < .0001）。在多变量分析中，住院医师的信心随着培训水平的提高而增加（PGY-1住院医师有信心处理24.9%的事件，而PGY-3/4住院医师有信心处理72.5%的事件，P < .0001），且与接触水平相关，与培训年份无关（P = .001）。确定了即将毕业的住院医师接触和信心水平最低的事件。
内科住院医师处理住院急性事件的信心与培训水平和临床接触情况相关。我们确定了住院医师接触和信心水平较低的事件，这些事件可作为未来课程开发的目标。
