a Department of Medicine , Duke University , Durham , NC , USA.
b Department of Pediatrics , Duke University , Durham , NC , USA.
Med Educ Online. 2019 Dec;24(1):1605783. doi: 10.1080/10872981.2019.1605783.
The transition from pediatric to adult healthcare is a vulnerable time for adolescents and young adults (AYA), especially those with chronic conditions. Successful transition requires communication and coordination amongst providers, patients, and families. Unfortunately, multiple studies have demonstrated that the majority of practicing providers do not feel prepared to help AYA patients through health care transition, but little is known about the transition/transfer aptitudes of physician trainees.
The purpose of this study was to establish the transition/transfer training that residents and fellows from different fields receive - and determine what training factors are associated with increased confidence in core transition/transfer skills.
A 20-item electronic survey regarding experiences caring for AYA patients was sent to all 2014-2015 graduate medical education (GME) trainees at our institution.
Forty-nine percent (479/985) of trainees responded: 60 pediatric, 387 non-pediatric, and 32 'combined' (e.g., Medicine/Pediatrics or Family Medicine). Trainees from all three categories of programs reported similar exposure to AYA patients with chronic conditions, with a median of 1-3 encounters per month. A quarter of trainees rated themselves as 'not at all prepared' to speak with a counterpart provider about a transferring patient, while nearly half of trainees considered themselves 'not at all prepared' to speak with a patient and family about transition. Trainee confidence in performing these two skills was strongly predicted by three factors: increased exposure to AYA with chronic conditions, education (training or role modeling) in transition skills, and experience practicing transition skills. Of these, the strongest association with trainee confidence was experience practicing the skills of communicating with other providers (OR = 13.0) or with patients/families (OR = 14.5).
Despite at least monthly encounters with AYA with chronic conditions, most residents and fellows have very little experience communicating across the pediatric-to-adult healthcare divide, highlighting training opportunities in graduate medical education.
从儿科到成人医疗保健的过渡时期对于青少年和年轻人（AYA）来说是一个脆弱的时期，尤其是那些患有慢性疾病的人。成功的过渡需要提供者、患者和家庭之间的沟通和协调。不幸的是，多项研究表明，大多数执业医生都觉得自己无法帮助 AYA 患者完成医疗保健过渡，但对于医学生的过渡/转移能力知之甚少。
本研究的目的是确定不同领域的住院医师和研究员接受的过渡/转移培训，并确定哪些培训因素与核心过渡/转移技能的信心增加相关。
我们向机构内所有 2014-2015 年毕业的住院医师和研究员发送了一份关于照顾 AYA 患者经验的 20 项电子调查。
49%（479/985）的住院医师和研究员做出了回应：60 名儿科住院医师、387 名非儿科住院医师和 32 名“混合”（例如，医学/儿科或家庭医学）。来自所有三个类别的住院医师报告了类似的接触患有慢性疾病的 AYA 患者，每月中位数为 1-3 次就诊。四分之一的住院医师表示自己“完全没有准备”与交接患者的对方提供者交谈，而近一半的住院医师认为自己“完全没有准备”与患者和家属谈论过渡。住院医师对执行这两项技能的信心强烈预测了三个因素：增加接触患有慢性疾病的 AYA，接受过渡技能的教育（培训或角色扮演），以及实践过渡技能的经验。其中，与住院医师信心最相关的是与其他提供者（OR=13.0）或与患者/家属（OR=14.5）沟通的技能实践经验。
尽管至少每月与患有慢性疾病的 AYA 接触，但大多数住院医师和研究员在跨越儿科到成人医疗保健鸿沟方面几乎没有经验，这突显了研究生医学教育中的培训机会。
