Kim Jung G, Rodriguez Hector P, Shortell Stephen M, Fuller Bruce, Holmboe Eric S, Rittenhouse Diane R
J.G. Kim is lecturer, University of California, Berkeley School of Public Health, Berkeley, California, and Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, California.
H.P. Rodriguez is Henry J. Kaiser Endowed Chair in Organized Health Systems and professor, University of California, Berkeley School of Public Health, Berkeley, California.
Acad Med. 2021 Mar 1;96(3):433-440. doi: 10.1097/ACM.0000000000003522.
Despite the importance of training in ambulatory care settings for residents to acquire important competencies, little is known about the organizational and environmental factors influencing the relative amount of time primary care residents train in ambulatory care during residency. The authors examined factors associated with postgraduate year 1 (PGY-1) residents' ambulatory care training time in Accreditation Council for Graduate Medical Education (ACGME)-accredited primary care programs.
U.S.-accredited family medicine (FM) and internal medicine (IM) programs' 2016-2017 National Graduate Medical Education (GME) Census data from 895 programs within 550 sponsoring institutions (representing 13,077 PGY-1s) were linked to the 2016 Centers for Medicare and Medicaid Services Cost Reports and 2015-2016 Area Health Resource File. Multilevel regression models examined the association of GME program characteristics, sponsoring institution characteristics, geography, and environmental factors with PGY-1 residents' percentage of time spent in ambulatory care.
PGY-1 mean (standard deviation, SD) percent time spent in ambulatory care was 25.4% (SD, 0.4) for both FM and IM programs. In adjusted analyses (% increase [standard error, SE]), larger faculty size (0.03% [SE, 0.01], P < .001), sponsoring institution's receipt of Teaching Health Center (THC) funding (6.6% (SE, 2.7), P < .01), and accreditation warnings (4.8% [SE, 2.5], P < .05) were associated with a greater proportion of PGY-1 time spent in ambulatory care. Programs caring for higher proportions of Medicare beneficiaries spent relatively less time in ambulatory care (< 0.5% [SE, 0.2], P < .01).
Ambulatory care time for PGY-1s varies among ACGME-accredited primary care residency programs due to the complex context and factors primary care GME programs operate under. Larger ACGME-accredited FM and IM programs and those receiving federal THC GME funding had relatively more PGY-1 time spent in ambulatory care settings. These findings inform policies to increase resident exposure in ambulatory care, potentially improving learning, competency achievement, and primary care access.
尽管门诊护理环境中的培训对于住院医师获得重要能力至关重要，但对于影响初级护理住院医师在住院期间门诊护理培训相对时间量的组织和环境因素却知之甚少。作者研究了与研究生医学教育认证委员会（ACGME）认证的初级护理项目中一年级（PGY-1）住院医师门诊护理培训时间相关的因素。
将美国认证的家庭医学（FM）和内科（IM）项目在550个主办机构内的895个项目的2016 - 2017年全国研究生医学教育（GME）普查数据（代表13,077名PGY-1）与2016年医疗保险和医疗补助服务中心成本报告以及2015 - 2016年地区卫生资源文件相关联。多级回归模型研究了GME项目特征、主办机构特征、地理位置和环境因素与PGY-1住院医师在门诊护理中花费时间的百分比之间的关联。
FM和IM项目中PGY-1在门诊护理中花费时间的平均（标准差，SD）百分比均为25.4%（SD，0.4）。在调整分析中（增加百分比[标准误，SE]），更大的教师规模（0.03%[SE，0.01]，P <.001）、主办机构获得教学健康中心（THC）资金（6.6%（SE，2.7），P <.01）以及认证警告（4.8%[SE，2.5]，P <.05）与PGY-1在门诊护理中花费的时间比例更高相关。照顾医疗保险受益比例较高的项目在门诊护理中花费的时间相对较少（<0.5%[SE，0.2]，P <.01）。
由于初级护理GME项目所处的复杂背景和因素，ACGME认证的初级护理住院医师项目中PGY-1的门诊护理时间各不相同。规模较大的ACGME认证的FM和IM项目以及那些获得联邦THC GME资金的项目，PGY-1在门诊护理环境中花费的时间相对更多。这些发现为增加住院医师在门诊护理中的接触机会的政策提供了信息，可能会改善学习、能力达成以及初级护理服务的可及性。
