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内科住院医师对晨交班的看法:一项多中心调查。

Internal Medicine Residents' Perceptions of Morning Report: a Multicenter Survey.

机构信息

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.

VA Puget Sound Health Care System, Seattle, WA, USA.

出版信息

J Gen Intern Med. 2021 Mar;36(3):647-653. doi: 10.1007/s11606-020-06351-7. Epub 2021 Jan 14.

Abstract

BACKGROUND

Residents rate morning report (MR) as an essential educational activity. Little contemporary evidence exists to guide medical educators on the optimal content or most effective delivery strategies, particularly in the era of resident duty-hour limitations and shifts towards learner-centric pedagogy in graduate medical education.

OBJECTIVE

Assess resident views about MR content and teaching strategies.

DESIGN

Anonymous, online survey.

PARTICIPANTS

Internal medicine residents from 10 VA-affiliated residency programs.

MAIN MEASURES

The 20-item survey included questions on demographics; frequency and reason for attending; opinions on who should attend, who should teach, and how to prioritize the teaching; and respondents' comfort level with participating in MR. The survey included a combination of Likert-style and multiple-choice questions with the option for multiple responses.

KEY RESULTS

A total of 497 residents (46%) completed the survey, with a balanced sample of R1s (33%), R2s (35%), and R3s (31%). Self-reported MR attendance was high (31% always attend; 39% attend > 50% of the time), with clinical duties being the primary barrier to attendance (85%). Most respondents felt that medical students (89%), R1 (96%), and R2/R3s (96%) should attend MR; there was less consensus regarding including attendings (61%) or fellows (34%). Top-rated educational topics included demonstration of clinical reasoning (82%), evidence-based medicine (77%), and disease pathophysiology (53%). Respondents valued time spent on diagnostic work-up (94%), management (93%), and differential building (90%). Overall, 82% endorsed feeling comfortable speaking; fewer R1s reported comfort (76%) compared with R2s (87%) or R3s (83%, p = 0.018). Most (81%) endorsed that MR was an inclusive learning environment (81%), with no differences by level of training.

CONCLUSIONS

MR remains a highly regarded, well-attended educational conference. Residents value high-quality cases that emphasize clinical reasoning, diagnosis, and management. A supportive, engaging learning environment with expert input and concise, evidence-based teaching is desired.

摘要

背景

住院医师将晨交班(MR)视为一项重要的教育活动。尽管在住院医师工作时间限制和以学习者为中心的教学方法在研究生医学教育中盛行的时代,当代很少有证据可以指导医学教育工作者选择最佳的内容或最有效的教学策略,但仍有必要了解住院医师对 MR 内容和教学策略的看法。

目的

评估住院医师对 MR 内容和教学策略的看法。

设计

匿名在线调查。

参与者

来自 10 个退伍军人事务部附属住院医师项目的内科住院医师。

主要测量指标

20 项调查包括人口统计学问题;参加频率和原因;关于谁应该参加、谁应该教授以及如何确定教学优先级的意见;以及受访者对参与 MR 的舒适度。该调查包括一系列李克特量表和多项选择题,并提供多项选择。

主要结果

共有 497 名住院医师(46%)完成了调查,其中 R1(33%)、R2(35%)和 R3(31%)的比例均衡。自我报告的 MR 出席率很高(31%的人总是参加;39%的人参加超过 50%的时间),临床职责是出席的主要障碍(85%)。大多数受访者认为医学生(89%)、R1(96%)和 R2/R3(96%)应该参加 MR;对于是否包括主治医生(61%)或研究员(34%),则没有达成共识。评价最高的教育主题包括展示临床推理(82%)、循证医学(77%)和疾病病理生理学(53%)。受访者重视诊断检查(94%)、管理(93%)和鉴别诊断(90%)方面的时间。总体而言,82%的人表示对发言感到舒适;R1 报告的舒适度(76%)低于 R2(87%)或 R3(83%,p=0.018)。大多数人(81%)认为 MR 是一个包容的学习环境(81%),不同培训水平之间没有差异。

结论

MR 仍然是一项备受推崇且出席率很高的教育会议。住院医师重视强调临床推理、诊断和管理的高质量病例。他们希望有一个支持性、参与性的学习环境,有专家参与,并进行简洁、基于证据的教学。

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