Zeller Timothy A, Ewing Joseph A, Asif Irfan M
Department of Family Medicine, Greenville Health System, University of South Carolina School of Medicine Greenville, Seneca, SC.
Quality Management Department, Greenville Health System, Greenville, SC.
Fam Med. 2019 Apr;51(4):338-343. doi: 10.22454/FamMed.2019.666943.
Clinic First residency curricular approaches hold promise as models to successfully prepare primary care residents for future practice. The objective of our study was to estimate the prevalence of the Clinic First model in current family medicine residency training environments, and assess beliefs surrounding curricular structure and postgraduate practice.
An eight-question survey was conducted among Association of Family Medicine Residency Directors (AFMRD) members in 2017. Data were grouped and analyzed for statistical significance and correlation using analysis of variance, Kendall's τ, χ2, and Fisher exact test.
Two hundred-eleven AFMRD members responded to the survey; 27% described their current curriculum as Clinic First; 68% stated that their ideal curriculum is Clinic First. Residents in Clinic First programs spend more half-days in continuity clinic per week compared with traditional programs during PGY1 (1.79, 1.39, P=0.001) and PGY2 (3.18, 2.90, P=0.024). In group analyses, 63% of Clinic First respondents prioritized clinic in developing resident schedules, compared with 8% of traditional respondents (P<0.001). Seventy-four percent of Clinic First respondents described their philosophy as full spectrum, compared with 93% of traditional respondents (P<0.001). Seventy-five percent of respondents listed their graduates' most common practice type as outpatient practice, and there were no differences between groups (P=0.361). Sixty-one percent of traditional respondents stated that their ideal curriculum is Clinic First (P<0.001).
There is a high level of interest in the Clinic First model as a tool to prepare residents for future practice, but barriers to implementation need to be explored and addressed.
临床优先住院医师培训课程模式有望成为成功培养初级保健住院医师以适应未来临床实践的典范。我们研究的目的是评估当前家庭医学住院医师培训环境中临床优先模式的普及程度，并评估围绕课程结构和毕业后实践的看法。
2017年对家庭医学住院医师培训主任协会（AFMRD）成员进行了一项包含8个问题的调查。使用方差分析、肯德尔τ检验、卡方检验和费舍尔精确检验对数据进行分组和分析，以确定统计学意义和相关性。
211名AFMRD成员回复了调查；27%将其当前课程描述为临床优先；68%表示他们理想的课程是临床优先。与传统课程相比，临床优先项目的住院医师在PGY1阶段（1.79对1.39，P = 0.001）和PGY2阶段（3.18对2.90，P = 0.024）每周在连续性诊所的半天时间更多。在分组分析中，63%的临床优先受访者在制定住院医师排班时将诊所放在首位，而传统受访者中这一比例为8%（P<0.001）。74%的临床优先受访者将他们的理念描述为全领域，而传统受访者中这一比例为93%（P<0.001）。75%的受访者将其毕业生最常见的执业类型列为门诊执业，两组之间无差异（P = 0.361）。61%的传统受访者表示他们理想的课程是临床优先（P<0.001）。
作为一种让住院医师为未来实践做好准备的工具，临床优先模式受到了高度关注，但实施过程中的障碍需要探索和解决。
