Audétat M-C, Cairo Notari S, Sader J, Ritz C, Fassier T, Sommer J M, Nendaz M, Caire-Fon N
Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
BMC Med Educ. 2021 Jan 7;21(1):31. doi: 10.1186/s12909-020-02459-w.
Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients.
A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a "button camera" (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches.
Study results will contribute to the scientific community's overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient's care and treatments.
基层医疗医生是管理患有多种疾病患者的核心力量。然而，多项研究表明，一些医生觉得自己没有足够的能力来处理这类复杂的临床情况。关于患有多种疾病患者的长期管理和随访过程中所涉及的临床推理过程的研究较少。本研究旨在更好地理解在对这些患者的随访咨询过程中，基层医疗医生的临床推理是如何受到影响的。
将开展一项定性研究项目，采用视频刺激回忆访谈法，对门诊环境中的基层医疗医生进行半结构化访谈。在与患有多种疾病的患者进行标准咨询期间，使用别在他们白大褂上的“纽扣相机”（小型相机）在其工作环境中对参与者进行拍摄。该录像将用于后续与医生和研究团队的半结构化访谈中，以引发刺激回忆。刺激回忆是一种研究方法，通过邀请参与者在视频序列回忆的提示下回忆事件发生时他们同时进行的思考，从而对认知过程进行调查。在这次访谈中，参与者将受到不同视频序列的提示并被要求进行讨论；目的是鼓励他们阐明自己的临床推理过程。计划进行15至20次访谈以达到数据饱和。访谈将逐字转录，数据将根据标准内容分析，采用演绎和归纳方法进行分析。
研究结果将有助于科学界对临床推理的全面理解。这随后将使未来的基层医疗医生能够获得更充分的培训，以便在实践中管理患有多种疾病的患者。因此，这将提高患者护理和治疗的质量。
