Guy's and St Thomas' NHS Foundation Trust, London, UK
University College London, London, UK.
Clin Med (Lond). 2020 May;20(3):e26-e31. doi: 10.7861/clinmed.2019-0433.
Fluid management is an essential competency for hospital doctors, but previous studies suggest junior clinicians lack the necessary 'knowledge' and 'prescription skills' to complete this task, resulting in preventable morbidity and mortality. In this study, preregistration (n=146), core (n=66) and specialty (n=133) medical trainees and general medical consultants (n=11) completed a structured questionnaire exploring fluid management training, confidence, serious adverse event experience and a 20-item fluid management 'knowledge' test. Results were compared with those of intensive care consultants (n=20). Most clinicians reported limited training and extensive 'unreported' serious adverse events experience. Knowledge about fluid and electrolyte requirements, fluid composition and chloride toxicity had improved compared to historical reports but overall test scores (median (interquartile range (IQR)): with a maximum score of 20) were low. Foundation year trainees scored 7 (IQR 5-8), core medical trainees scored 9 (IQR 6-10), specialist registrars scored 8 (IQR 6-10) and general medical consultants scored 8 (IQR 6-12) compared with the intensive care consultant score of 16 (IQR 14-16). Although weakly correlated, fluid management 'confidence' appeared higher than 'knowledge' tests would justify. These results suggest that physicians' fluid management knowledge is inadequate, including that of senior colleagues, compounded by poor training and failure to learn from serious adverse events.
液体管理是医院医生的一项基本技能，但先前的研究表明，初级临床医生缺乏完成这项任务所需的“知识”和“处方技能”，导致可预防的发病率和死亡率。在这项研究中，住院医师（n=146）、核心医师（n=66）和专科医师（n=133）以及普通内科顾问（n=11）完成了一项结构化问卷，调查液体管理培训、信心、严重不良事件经验以及 20 项液体管理“知识”测试。结果与重症监护顾问（n=20）进行了比较。大多数临床医生报告说，他们接受的培训有限，并且有广泛的“未报告”严重不良事件经验。与历史报告相比，关于液体和电解质需求、液体成分和氯化物毒性的知识有所提高，但总体测试成绩（中位数（四分位距（IQR））：最高得分为 20）较低。基础年受训者得分为 7（IQR 5-8），核心医学受训者得分为 9（IQR 6-10），专科住院医师得分为 8（IQR 6-10），普通内科顾问得分为 8（IQR 6-12），而重症监护顾问得分为 16（IQR 14-16）。尽管相关性较弱，但液体管理“信心”似乎高于“知识”测试的结果。这些结果表明，医生的液体管理知识不足，包括资深同事的知识，这是由于培训不足和未能从严重不良事件中吸取教训造成的。
