McGrail Carolyn, Urban Josie, Church Brandy, Corser William D
Authority Health, Detroit, MI.
Michigan State University College of Osteopathic Medicine, Statewide Campus System.
Spartan Med Res J. 2016 Oct 24;1(1):5097. doi: 10.51894/001c.5097.
It is now increasingly recognized that physicians should be engaged in quality improvement/patient safety (QIPS) activities to make their patient care systems perform more reliably and safely. In order to ensure that our nation's physicians embed this aspect of practice into their work, there also is a growing expectation for effective integration of QIPS training into graduate medical education. This exploratory pilot study was conducted to identify how residents' personal and residency program characteristics might be related to their perceived confidence to develop and conduct prospective QIPS projects.
A total non-probability convenience sample of 43 DO resident physicians from five residency programs (Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Psychiatry) at Authority Health were surveyed from 09/28/2015 to 01/06/2016 using online Survey Monkey software. A 38-item survey asked residents about their personal and residency program characteristics, as well as their current overall perceived confidence to develop and conduct QIPS projects.
Two model terms that proved non-significant during analyses were residents' age category and year in residency training. In the final stepwise multinomial regression model, however, three covariates including: a) sex (p=0.045), b) being in a primary care residency program (p=0.038) and c) having had prior QIPS project experience (p=0.049) were each found to be statistically significant predictors of respondents' perceived comfort level categories. Male residents and those who were in a primary care residency program (i.e., Family Medicine, Internal Medicine or Pediatrics), and/or reported having had prior QIPS project experience, reported significantly higher confidence levels.
Somewhat similar to earlier studies, these results suggest the need to incorporate QIPS education for resident trainees across the nation. Ideally, the findings from larger resident studies will enable GME leaders to develop and deliver evidence-based QIPS curricula that are better oriented to resident physicians' personal characteristics and preferences.
如今，人们越来越认识到医生应参与质量改进/患者安全（QIPS）活动，以使他们的患者护理系统更可靠、更安全地运行。为确保我国医生将这一实践方面融入其工作，人们也越来越期望将QIPS培训有效地融入毕业后医学教育。本探索性试点研究旨在确定住院医师的个人特征和住院医师培训项目特征如何与他们开展前瞻性QIPS项目的感知信心相关。
2015年9月28日至2016年1月6日，使用在线Survey Monkey软件对权威健康中心五个住院医师培训项目（家庭医学、内科、妇产科、儿科和精神病学）的43名医学博士住院医师进行了非概率便利抽样调查。一项包含38个条目的调查询问了住院医师的个人特征和住院医师培训项目特征，以及他们目前开展QIPS项目的总体感知信心。
分析中被证明无统计学意义的两个模型项是住院医师的年龄类别和住院医师培训年份。然而，在最终的逐步多项回归模型中，发现三个协变量具有统计学意义，包括：a）性别（p=0.045），b）参加初级保健住院医师培训项目（p=0.038），c）有QIPS项目经验（p=0.049），这些都是受访者感知舒适度类别的显著预测因素。男性住院医师、参加初级保健住院医师培训项目（即家庭医学、内科或儿科）的住院医师，以及/或者报告有QIPS项目经验的住院医师，报告的信心水平显著更高。
与早期研究 somewhat similar ，这些结果表明有必要在全国范围内为住院医师培训学员开展QIPS教育。理想情况下，更大规模住院医师研究的结果将使毕业后医学教育领导者能够开发并提供更符合住院医师个人特征和偏好的循证QIPS课程。 （注：原文中“somewhat similar”翻译为“ somewhat similar”，可能存在拼写错误，推测应为“somewhat similar”，直译为“有点相似”，但此处表述不太符合语境逻辑，疑原文有误，具体含义需结合完整研究背景确定。）
