长远的游戏：住院医师和专科医师培训期间临床决策的演变。
The long game: Evolution of clinical decision making throughout residency and fellowship.
机构信息
Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA.
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, The Ohio State University, Starling-Loving Hall, 320 West 10th Ave, Columbus, OH, 43210, USA.
出版信息
Am J Surg. 2022 Feb;223(2):266-272. doi: 10.1016/j.amjsurg.2021.03.023. Epub 2021 Mar 18.
BACKGROUND
The purpose of this study was to explore the trajectory of autonomy in clinical decision making.
METHODS
We conducted a qualitative secondary analysis of interviews with 45 residents and fellows from the General Surgery and Obstetrics & Gynecology departments across all clinical postgraduate years (PGY) using convenience sampling. Each interview was recorded, transcribed and iteratively analyzed using a framework method.
RESULTS
A total of 16 junior residents, 22 senior residents and 7 fellows participated in 12 original interviews. Early in training residents take their abstract ideas about disease processes and make them concrete in their applications to patient care. A transitional stage follows in which residents apply concepts to concrete patient care. Chief residents re-abstract their concrete technical and clinical knowledge to prepare for future surgical practice.
CONCLUSIONS
Understanding where each learner is on this pathway will assist development of curriculum that fosters resident readiness for practice at each PGY level.
背景
本研究旨在探讨临床决策自主性的发展轨迹。
方法
我们采用便利抽样法，对普外科和妇产科的 45 名住院医师和研究员进行了定性二次分析。对所有临床住院医师培训年限（PGY）的访谈进行录音、转录，并使用框架方法进行迭代分析。
结果
共有 16 名初级住院医师、22 名高级住院医师和 7 名研究员参加了 12 次原始访谈。在培训早期，住院医师将他们对疾病过程的抽象概念应用于患者护理中，使这些概念变得具体。随后是一个过渡阶段，住院医师将概念应用于具体的患者护理中。住院总医师重新抽象他们的具体技术和临床知识，为未来的手术实践做准备。
结论
了解每个学习者在这条路径上的位置将有助于制定课程，促进住院医师在每个 PGY 水平上做好实践准备。
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