全科医学轮转培训对 11244 名日本住院医师住院医师考试成绩的影响：一项全国多中心横断面研究。
Impact of general medicine rotation training on the in-training examination scores of 11, 244 Japanese resident physicians: a Nationwide multi-center cross-sectional study.
机构信息
Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Shimotuga-gun, Mibumachi, Tochigi, 321-0293, Japan.
出版信息
BMC Med Educ. 2020 Nov 13;20(1):426. doi: 10.1186/s12909-020-02334-8.
BACKGROUND
Although general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents' rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score.
METHODS
This study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score.
RESULTS
A total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00).
CONCLUSIONS
GM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan.
背景
尽管日本医学院校的全科医学（GM）教师在医学生教育中发挥着重要作用，但在日本，住院医师在 GM 部门轮转培训的重要性尚未得到充分认识。本研究旨在评估住院医师在 GM 部门轮转与住院医师年度考核（GM-ITE）成绩之间的关系。
方法
本研究是日本一项全国多中心的横断面研究。研究对象为参加过 2016 年至 2018 年至少一次 GM-ITE 考试的日本初级住院医师（PGY-1 和 PGY-2）[研究生年级（PGY）-1 和 PGY-2]，共 11244 人。2016 年、2017 年和 2018 年参加 GM-ITE 的医院数量分别为 381 家、459 家和 503 家。GM-ITE 成绩包括四个类别（医学面试/专业精神、症状/临床推理、体检/操作和疾病知识）。我们评估了教育环境（包括医院信息）与 GM-ITE 评分之间的关系。
结果
共有 4464 名（39.7%）住院医师接受了 GM 部门的轮转培训。接受 GM 轮转培训的住院医师总得分高于未接受 GM 轮转培训的住院医师（接受 GM 轮转培训、未在有 GM 部门的医院接受 GM 轮转培训和未在无 GM 部门的医院接受 GM 轮转培训的住院医师总得分分别为 38.1±12.1、36.8±11.7 和 36.5±11.5，p=0.0038）。在多水平模型中，经过多变量调整后，GM 轮转与能力之间的关联仍然存在：与无 GM 部门的医院中的非 GM 轮转住院医师相比，GM 轮转培训住院医师的得分差异估计为 1.18（标准误差 0.30，p=0.0001），这大约是医院变异（估计为 2.00）引起的随机效应标准偏差的一半。
结论
GM 轮转培训提高了住院医师的 GM-ITE 成绩，应考虑在日本对初级住院医师强制进行 GM 轮转培训。
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