Sturman Nancy J, Tapley Amanda, van Driel Mieke L, Holliday Elizabeth G, Ball Jean I, Davey Andrew R, Fielding Alison, FitzGerald Kristen, Spike Neil A, Magin Parker J
Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, 8th Floor, Health Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4006, Australia.
School of Public Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
BMC Med Educ. 2020 Oct 19;20(1):369. doi: 10.1186/s12909-020-02291-2.
General practice (GP) trainees may seek supervisor assistance to complete their patient consultations. This in-consultation assistance plays a key role in the supervisory oversight of trainees and in trainee learning. It may be obtained face-to-face, or using phone or messaging systems, and either in front of patients or outside their hearing. Trainee concerns about decreased patient impressions of their competence, and discomfort presenting patients within their hearing, act as barriers to seeking help during consultations. Little is known about the frequency and associations of trainee concerns about these patient-related barriers, or the various trainee-supervisor-patient configurations used to obtain in-consultation assistance.
Australian GP trainees rated their frequency of use of five specific configurations for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients' hearing. Statistical analyses included descriptive statistics and multivariable logistic regression.
Responses were received from 778 Australian GP trainees (response rate 89%). Help-seeking configurations did not differ between trainees at different training stages, except for greater use of electronic messaging in later stages. In-consultation assistance was most commonly provided by phone between trainee and supervisor consulting rooms, or outside the trainee's patient's hearing. Supervisor assistance in the trainee's room face-to-face with the patient was reported as either never or rarely obtained by 12% of respondents. More trainees (25%) perceived that patient impressions of their competence increased after help-seeking than perceived that these impressions decreased (19%). Most trainees (55%) preferred to present patients outside their hearing. Trainee age was the only variable associated with both patient-related barriers.
Supervisors appear to have considerable influence over trainee help-seeking, including which configurations are used and trainee perceptions of patient-related barriers. In-consultation supervision may actually increase trainee perceptions of patient impressions of their competence. Many supervisors and trainees may benefit from additional educational and workplace interventions to facilitate comfortable and effective trainee help-seeking in front of patients. More work is required to understand the clinical and educational implications of different help-seeking configurations when trainees require 'just in time' supervisor assistance.
全科医学（GP）实习生可能会寻求上级医生的帮助来完成患者咨询。这种咨询过程中的协助在对实习生的监督管理以及实习生学习方面起着关键作用。可以通过面对面、电话或信息系统来获得这种协助，并且可以在患者面前或在患者听不到的情况下进行。实习生担心患者对其能力的印象会降低，以及在患者能听到的情况下介绍患者会感到不适，这些都成为他们在咨询过程中寻求帮助的障碍。对于实习生对这些与患者相关的障碍的担忧频率及关联因素，以及用于获得咨询过程中协助的各种实习生 - 上级医生 - 患者组合情况，我们了解得很少。
澳大利亚的全科医学实习生对用于获得咨询过程中协助的五种特定组合的使用频率、获得这种协助后他们认为患者对其能力的印象有何变化，以及与在患者能听到的情况下相比，在患者听不到的情况下介绍患者时实习生的相对舒适度进行了评分。统计分析包括描述性统计和多变量逻辑回归。
共收到778名澳大利亚全科医学实习生的回复（回复率89%）。不同培训阶段的实习生在寻求帮助的组合方式上没有差异，只是后期阶段更多地使用电子信息。咨询过程中的协助最常见的是通过实习生和上级医生诊室之间的电话，或者在实习生的患者听不到的情况下进行。12%的受访者表示从未或很少获得上级医生在实习生房间与患者面对面提供的协助。更多的实习生（25%）认为寻求帮助后患者对其能力的印象有所提高，而认为印象降低的实习生占19%。大多数实习生（55%）更喜欢在患者听不到的情况下介绍患者。实习生年龄是与这两个与患者相关的障碍都有关联的唯一变量。
上级医生似乎对实习生寻求帮助有很大影响，包括使用哪种组合方式以及实习生对与患者相关的障碍的认知。咨询过程中的监督实际上可能会增强实习生对患者对其能力印象的认知。许多上级医生和实习生可能会从额外的教育和工作场所干预措施中受益，这些措施有助于实习生在患者面前舒适且有效地寻求帮助。当实习生需要“及时”的上级医生协助时，还需要开展更多工作来了解不同寻求帮助组合方式的临床和教育意义。
