George Sheenagh J K, Manos Sarah, Wong Kenny K
Department of Pediatrics, Dalhousie University Pediatrics Residency Program, Dalhousie University, Halifax, Nova Scotia.
Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.
Paediatr Child Health. 2020 Jan 22;26(2):88-92. doi: 10.1093/pch/pxz169. eCollection 2021 Apr-May.
The Royal College of Physicians and Surgeons of Canada officially launched 'Competence by Design' in July 2017, moving from time-based to outcomes-based training. Transitioning to competency-based medical education (CBME) necessitates change in resident assessment. A greater frequency of resident observation will likely be required to adequately assess whether entrustable professional activities have been achieved.
Characterize faculty and resident experiences of direct observation in a single paediatric residency program, pre-CBME implementation. Qualitatively describe participants' perceived barriers and incentives to participating in direct observation.
Surveys were sent to paediatric residents and faculty asking for demographics, the frequency of resident observation during an average 4-week rotation, perceived ideal frequency of observation, and factors influencing observation frequency. Descriptive data were analyzed. Institutional research ethics board approval was received.
The response rate was 54% (34/68 faculty and 16/25 residents). When asked the MAXIMUM frequency FACULTY observed a resident take a history, perform a physical examination, or deliver a plan, the median faculty reply was 1, 2, and 3, for outpatient settings and 0, 1, and 2, for inpatient settings. The median RESIDENT reply was 2, 4, and 10 for outpatient settings and 1, 2, and 20 for inpatient settings. When asked the MINIMUM frequency for each domain, the median FACULTY and RESIDENT reply was 0, except for delivering a plan in the inpatient setting. Faculty reported observing seniors delivering the plan more frequently than junior residents. Faculty and resident median replies for how frequently residents should be observed for each domain were the same, three to four, three to four, and five to six times. Four per cent of faculty reported regularly scheduling observations, and 77% of residents regularly ask to be observed. The most common barriers to observation were too many patients to see and both faculty and residents were seeing patients at the same time. Most faculty and resident responders felt that observation frequency could be improved if scheduled at the start of the rotation; faculty were provided a better tool for assessment; and if residents asked to be observed.
This study provides baseline data on how infrequent faculty observation is occurring and at a frequency lower than what faculty and residents feel is necessary. The time needed for observation competes with clinical service demands, but better scheduling strategies and assessment tools may help.
加拿大皇家内科医师与外科医师学院于2017年7月正式推出“以设计促能力提升”，从基于时间的培训转向基于结果的培训。向基于能力的医学教育（CBME）转变需要改变住院医师评估方式。可能需要更频繁地观察住院医师，以充分评估其是否已实现可托付的专业活动。
描述在单一儿科住院医师培训项目中，CBME实施前直接观察的教员和住院医师的经历。定性描述参与者对参与直接观察的感知障碍和激励因素。
向儿科住院医师和教员发送调查问卷，询问人口统计学信息、平均4周轮转期间住院医师观察的频率、理想的观察频率以及影响观察频率的因素。对描述性数据进行分析。获得了机构研究伦理委员会的批准。
回复率为54%（教员68人中34人回复，住院医师25人中16人回复）。当被问及教员观察住院医师进行病史采集、体格检查或制定治疗计划的最高频率时，教员对于门诊环境的中位数回复分别为1次、2次和3次，住院环境为0次、1次和2次。住院医师对于门诊环境的中位数回复分别为2次、4次和10次，住院环境为1次、2次和20次。当被问及每个领域的最低频率时，教员和住院医师的中位数回复均为0次，但住院环境下制定治疗计划除外。教员报告观察高年级住院医师制定治疗计划的频率高于低年级住院医师。教员和住院医师对于每个领域观察住院医师频率的中位数回复相同，分别为三到四次、三到四次和五到六次。4%的教员报告定期安排观察，77%的住院医师定期请求被观察。观察的最常见障碍是要看护的患者太多以及教员和住院医师同时都在看诊患者。大多数教员和住院医师回复者认为，如果在轮转开始时安排观察、为教员提供更好的评估工具以及住院医师请求被观察，观察频率可以提高。
本研究提供了关于教员观察频率极低且低于教员和住院医师认为必要频率的基线数据。观察所需时间与临床服务需求相竞争，但更好的排班策略和评估工具可能会有所帮助。
