Anderson D C, Harris I B, Schultz A L
University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis.
J Med Educ. 1988 Sep;63(9):692-8. doi: 10.1097/00001888-198809000-00004.
Residents were surveyed about the characteristics and quality of their education before and twice after a new practice plan for faculty members was implemented at a county medical center. The residents assessed the impact of the practice plan on their training programs. Compared with the ratings before the plan began (1984), the responses one and two years (1985 and 1986) after institution of the plan were significantly more positive on three of nine characteristics: quality of staff, quality of supervision, and heterogeneity of patients. Contrary to concerns expressed by faculty members and residents prior to the plan, the 1985 and 1986 residents did not identify significant decline in the level of their patient care responsibility and opportunities for independent decision-making. One-third of the residents in 1985 and 1986, however, commented (usually negatively) about increased time required for attending rounds due to involvement of faculty members in ward care and documentation activities. These results suggest that changes in faculty organization to increase patient care reimbursement are not necessarily incompatible with maintaining and even improving graduate education.
在一家县医疗中心实施针对教员的新实践计划之前、实施之后两年，分别对住院医师进行了调查，询问他们教育的特点和质量。住院医师评估了该实践计划对他们培训项目的影响。与计划开始前（1984年）的评分相比，计划实施一年和两年后（1985年和1986年）的回复在九个特点中的三个方面明显更为积极：工作人员质量、监督质量和患者的异质性。与教员和住院医师在计划实施前表达的担忧相反，1985年和1986年的住院医师并未发现他们的患者护理责任水平和独立决策机会有显著下降。然而，1985年和1986年三分之一的住院医师（通常持负面态度）评论说，由于教员参与病房护理和文件记录活动，查房所需时间增加了。这些结果表明，为增加患者护理报销而对教员组织进行的变革不一定与维持甚至改善研究生教育相矛盾。
