Sheikh Fatima, Gathecha Evelyn, Arbaje Alicia I, Christmas Colleen
Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Med Educ Curric Dev. 2021 Jan 20;8:2382120520988590. doi: 10.1177/2382120520988590. eCollection 2021 Jan-Dec.
Suboptimal care transitions can lead to re-hospitalizations.
We developed a 2-week "Transitions of Care Curriculum" to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents.
The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents.Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis.
Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps.
This experiential learning and use of reflective writing enhanced the residents' self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.
护理过渡不佳可能导致再次住院。
我们制定了一个为期两周的“护理过渡课程”，以培训内科一年级住院医师，提高他们提供最佳过渡护理的知识和技能。我们的目标是通过反思性写作文章来评估该课程对住院医师的影响。
轮转包括：护理过渡教学模块、过渡审核、过渡护理实地考察和护理过渡会议。住院医师在课程期间执行护理过渡的上述要素，并就他们的经历撰写反思性文章。对这些文章进行分析，以评估该课程对住院医师的总体影响。使用反思性文章的定性分析来评估该课程的影响。在完成轮转的20名住院医师中，有18篇反思性文章可供定性分析。
反思性文章中确定的五个主要改进主题是：出院计划、以患者为中心的护理、护理连续性、护理目标讨论和患者安全。讨论最多的主题是护理连续性，其次是以下子主题：医疗系统的碎片化、对患者的护理脱节、导致护理缺乏连续性的患者特定因素、初级保健提供者作为护理协调员的角色缺失以及出院过程中的挑战。住院医师还确定了基于系统的差距，并提出了克服这些差距的解决方案。
这种体验式学习和反思性写作的运用增强了住院医师对护理过渡差距的自我认知意识，并促使他们提出系统改进的想法以及在护理过渡期间改善实践的个人行动方案。
