与基层医疗医学职业相关的因素：连续性临床经验很重要。

Factors Associated with a Career in Primary Care Medicine: Continuity Clinic Experience Matters.

机构信息

Division of General Internal Medicine, University of California, San Francisco, CA, USA.

Department of Medicine, University of California, San Francisco, CA, USA.

出版信息

J Gen Intern Med. 2021 Nov;36(11):3383-3387. doi: 10.1007/s11606-021-06625-8. Epub 2021 Feb 23.

DOI:10.1007/s11606-021-06625-8

PMID:33620629

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8606375/

Abstract

BACKGROUND

Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice.

METHODS

We conducted a cross-sectional electronic survey of a PC internal medicine alumni cohort (2000-2015) from a large, academic residency. Our primary predictor was PC career and our primary outcome was influential factors on career choice. We performed chi-squared or Fisher's exact tests for categorical variables and t tests for continuous variables.

RESULTS

Of the 317 PC alumni in the last 15 years, 305 were contacted. One hundred seventy-two (56%) responded with 94 (55%) reporting current careers in PC and 78 (45%) in non-PC fields. Ninety-four percent of respondents expressed interest prior to residency, while only 68% remained interested at the conclusion of residency. Sixty-one percent of PC alumni rated the overall clinic experience as the most influential factor towards their ultimate career choice. The patient-physician relationship was the most frequently endorsed positively influential factor in career choice in both groups (95% of PC alumni, 76% non-PC). There was no difference among all alumni in common frustrations of clinic including clerical duties, encounter documentation, or visit length. Similarly, resident debt did not differ between groups.

CONCLUSIONS

Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.

摘要

背景

由于对初级保健（PC）获得途径不足的担忧，美国卫生资源与服务管理局（HRSA）等国家机构支持 PC 住院医师培训。最近的研究表明，多达 35%的 PC 住院医师培训毕业生在培训期间对 PC 失去了兴趣。这些失去兴趣的校友表示，他们的连续性诊所体验影响了他们的职业选择。本研究旨在确定影响职业选择的 PC 住院医师培训经历的具体方面。

方法

我们对来自一个大型学术住院医师培训项目的 PC 内科住院医师培训毕业生队列（2000-2015 年）进行了横断面电子调查。我们的主要预测指标是 PC 职业，主要结局是影响职业选择的因素。我们对分类变量进行卡方检验或 Fisher 精确检验，对连续变量进行 t 检验。

结果

在过去 15 年中的 317 名 PC 校友中，有 305 名被联系到。172 名（56%）做出了回应，其中 94 名（55%）报告目前从事 PC 工作，78 名（45%）从事非 PC 领域工作。94%的受访者在住院医师培训前表示有兴趣，而只有 68%的人在住院医师培训结束时仍有兴趣。61%的 PC 校友将整体诊所体验评为对他们最终职业选择最有影响力的因素。医患关系是两组中最常被认为对职业选择有积极影响的因素（95%的 PC 校友，76%的非 PC 校友）。在诊所常见的挫折方面，所有校友之间没有差异，包括文书工作、就诊记录或就诊时间。同样，两组住院医师的债务也没有差异。