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三年的X+Y排班制:住院医师和教员认知的纵向评估

Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions.

作者信息

Myers Ross E, Thoreson Lynn, Howell Heather B, Poitevien Patricia, Wroblewski Mary Beth, Ponitz Keith, Lewis Joanna

机构信息

Department of Pediatrics (RE Myers, K Ponitz), Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio.

Department of Pediatrics (L Thoreson), The University of Texas at Austin Dell Medical School and Dell Children's Medical Center, Austin, Tex.

出版信息

Acad Pediatr. 2022 Sep-Oct;22(7):1097-1104. doi: 10.1016/j.acap.2022.01.014. Epub 2022 Feb 25.

Abstract

OBJECTIVE

Five pediatric residency programs implemented true X + Y scheduling in 2018 where residents have continuity clinic in "blocks" rather than half-day per week experiences. We report the impact X + Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences over a 3-year timeframe.

METHODS

Electronic surveys were sent to residents and faculty of the participating programs prior to implementing X + Y scheduling and annually thereafter (2018-2021). Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotations. Data were analyzed using z-tests for proportion differences.

RESULTS

One hundred and eight six residents were sent the survey preimplementation and 254 to 289 postimplementation with response rates ranging from 47% to 69%. Three hundred and seventy-eight to 395 faculty members were sent the survey with response rates ranging from 26% to 51%. Statistically significant (P < .05) sustained perceived improvements over 3 years with X+Y were seen in outpatient continuity, inpatient workflow, and time for teaching both inpatient and in continuity clinic.

CONCLUSIONS

X + Y scheduling can lead to perceived improvements in various aspects of pediatric residency programs. Our study demonstrates these improvements have been sustained over 3 years in the participating programs.

摘要

目的

2018年,五个儿科住院医师培训项目实施了真正的X+Y排班模式,即住院医师以“模块”形式进行连续性门诊,而非每周半天的门诊体验。我们报告了X+Y排班模式在三年时间内对儿科住院医师和教员在患者护理认知以及其他教育体验方面的影响。

方法

在实施X+Y排班模式之前以及此后每年(2018 - 2021年),向参与项目的住院医师和教员发送电子调查问卷。调查问题衡量住院医师和教员对连续性门诊排班满意度的认知,以及连续性门诊排班对住院和专科轮转的影响。使用z检验分析比例差异数据。

结果

在实施前向186名住院医师发送了调查问卷,实施后发送了254至289份,回复率在47%至69%之间。向378至395名教员发送了调查问卷,回复率在26%至51%之间。在三年时间里,X+Y排班模式在门诊连续性、住院工作流程以及住院和连续性门诊教学时间方面持续呈现出统计学上显著(P < .05)的认知改善。

结论

X+Y排班模式可使儿科住院医师培训项目在各个方面得到认知上的改善。我们的研究表明,这些改善在参与项目中持续了三年。

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