Vanderberg Rachel, Rothenberger Scott D, Spagnoletti Carla, McNeil Melissa
Division of General Internal Medicine, UPMC Montefiore Hospital, University of Pittsburgh School of Medicine, 200 Lothrop St., Suite 933 W, Pittsburgh, PA 15213 USA.
Center for Research on Health Care Data Center, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213 USA.
Med Sci Educ. 2019 Jul 24;29(4):929-934. doi: 10.1007/s40670-019-00773-7. eCollection 2019 Dec.
Outpatient exam room presentations (OERPs) in resident continuity clinic (RCC) can operationalize competency-based medical education and enhance patient satisfaction. We aimed to assess current OERP use and OERP barriers by surveying internal medicine attendings prior to and following a 4-week pilot of OERPs in RCC. Twenty-six out of an eligible 35 attendings completed the pre-pilot survey. Twenty attendings participated in the pilot and completed the post-pilot surveys. On the pre-pilot survey, 65% (17/26) of participants reported never using OERPs. Attendings' perception of learner discomfort with OERPs as somewhat of or a significant barrier significantly decreased from pre-pilot to post-pilot (96% (25/26) v. 65% (13/20), = 0.03). Time, feedback, and sensitive topics were frequently rated as barriers on both the pre-pilot and post-pilot surveys. On the post-pilot survey, most participants reported patient discomfort with OERPs, attending physician discomfort with OERPs, difficulty writing attestations during OERPs, and difficulty teaching during OERPs were not barriers. Additionally, 45% (9/20) reported planning to use OERPs in the future. Despite benefits of OERPs, there are several barriers to OERPs that need to be addressed prior to more routine implementation in resident continuity clinic. Further research should focus on strategies for overcoming barriers and maximizing benefits of OERPs as well as developing a set of OERP best practices to support routine implementation in RCC.
住院医师连续性诊所（RCC）中的门诊检查室汇报（OERP）可实施基于胜任力的医学教育并提高患者满意度。我们旨在通过在RCC对OERP进行为期4周的试点之前和之后对内科主治医师进行调查，来评估当前OERP的使用情况和OERP的障碍。在符合条件的35名主治医师中，有26名完成了试点前的调查。20名主治医师参与了试点并完成了试点后的调查。在试点前的调查中，65%（17/26）的参与者表示从未使用过OERP。从试点前到试点后，主治医师认为学习者对OERP感到不适是某种程度上的障碍或重大障碍的看法显著下降（96%（25/26）对65%（13/20），P = 0.03）。时间、反馈和敏感话题在试点前和试点后的调查中都经常被评为障碍。在试点后的调查中，大多数参与者报告患者对OERP感到不适、主治医师对OERP感到不适、在OERP期间撰写证明困难以及在OERP期间教学困难都不是障碍。此外，45%（9/20）的人报告计划在未来使用OERP。尽管OERP有诸多益处，但在住院医师连续性诊所更常规地实施之前，OERP仍存在一些需要解决的障碍。进一步的研究应侧重于克服障碍和最大化OERP益处的策略，以及制定一套OERP最佳实践以支持在RCC中的常规实施。
