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[关于对医学住院医师入职人员进行监督的必要性]

[On the need for supervision of the entrants to medical residences].

作者信息

Silva Carolina, Carozza Colombini María Natalia, Luiz Passarela Milena, Eymann Alfredo, Llera Julián

机构信息

Servicio de Clínica Pediátrica e Instituto Universitario, Hospital Italiano de Buenos Aires, Argentina. E-mail:

Servicio de Clínica Pediátrica e Instituto Universitario, Hospital Italiano de Buenos Aires, Argentina.

出版信息

Medicina (B Aires). 2019;79(5):384-390.

Abstract

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

摘要

根据美国医学院协会的说法,有13项核心可托付专业活动(EPA),医学毕业生在住院医师培训的第一天应能够在无直接监督的情况下执行。在阿根廷,EPA没有明确界定。此外,没有关于这些活动监督需求的本地数据。本研究的目的是评估住院医师和带教医师对住院医师第一个月执行EPA所需监督水平的估计。进行了一项横断面研究。纳入了一年级医学住院医师和带教医师。通过电子或纸质问卷进行调查,询问参与者估计住院医师在住院医师培训的第一个月执行13项核心EPA所需的监督水平。参与是自愿且匿名的。在13项EPA中的11项上,住院医师(n = 71)和带教医师(n = 39)的意见存在显著差异。除了询问临床问题和寻找证据外,超过一半的带教医师认为住院医师在执行EPA时需要直接监督。大多数住院医师认为他们在6项EPA中需要直接监督。总之,与带教医师相比,医学住院医师认为所需监督水平较低,带教医师认为医学毕业生在进入住院医师培训时若无直接监督则无法执行大多数EPA。因此,改进评估医学毕业生能力的程序以建立更准确的监督水平非常重要。

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