Rustici Matthew J, Moreira Maria, Buchanan Jennie, Rodrigues Kristine Knuti, Roosevelt Genie E
J Grad Med Educ. 2020 Apr;12(2):185-192. doi: 10.4300/JGME-D-19-00426.1.
According to the Accreditation Council for Graduate Medical Education emergency medicine (EM) program requirements, EM residents on EM rotations must be supervised by board-certified/board-prepared EM or pediatric EM (PEM) faculty.
We sought to understand the effect of allowing EM residents to be supervised by attending pediatricians while caring for pediatric urgent care patients.
The EM residents were permitted to staff pediatric urgent care patients with either an EM/PEM attending or an attending pediatrician from August 2017 to July 2018. Outcomes were assessed through resident focus groups, a mixed-methods survey of EM residents and EM/PEM/pediatrician attendings, and clinical outcomes, including length of stay, best evidence/clinical care guideline adherence, and 48-hour return visits requiring admission. Qualitative data were inductively coded using a phenomenological framework, with themes emerging from consensus discussion.
Ninety percent of residents participated in 1 of 7 focus groups. Four key themes emerged from qualitative analysis of focus group transcripts: (1) pediatricians have unique skills that complement those of EM physicians; (2) EM resident education improved; (3) patients may get better care with dual staffing; and (4) other PEM department and urgent care team members may have benefited from the change. The survey response rate was 72%, and it did not uncover additional themes. Length of stay was shorter for patients supervised by attending pediatricians (114 versus 128 minutes, < .001); there was no difference in best evidence/clinical care guideline adherence or 48-hour return visits requiring admission.
Physicians' perceived education was improved by adding complementary perspectives without significant negative consequences for learners or patients.
根据毕业后医学教育认证委员会急诊医学（EM）项目要求，参与急诊医学轮转的EM住院医师必须由获得委员会认证/具备委员会认证资格的EM或儿科急诊医学（PEM）教员进行监督。
我们试图了解在护理儿科急症患者时允许儿科医生监督EM住院医师的效果。
2017年8月至2018年7月期间，允许EM住院医师在护理儿科急症患者时由EM/PEM主治医师或儿科主治医师提供人员支持。通过住院医师焦点小组、对EM住院医师以及EM/PEM/儿科医生主治医师的混合方法调查，以及包括住院时间、最佳证据/临床护理指南依从性和需要入院的48小时复诊等临床结果来评估结局。定性数据采用现象学框架进行归纳编码，通过共识讨论得出主题。
90%的住院医师参加了7个焦点小组中的1个。焦点小组记录的定性分析得出了4个关键主题：（1）儿科医生具有补充EM医生技能的独特技能；（2）EM住院医师教育得到改善；（3）双重人员配置可能使患者得到更好的护理；（4）其他PEM科室和急症护理团队成员可能从这一变化中受益。调查回复率为72%，未发现其他主题。由儿科主治医师监督的患者住院时间较短（114分钟对128分钟，<0.001）；在最佳证据/临床护理指南依从性或需要入院的48小时复诊方面没有差异。
通过增加互补的观点，医生的感知教育得到了改善，对学习者或患者没有显著负面影响。
