Stanford University School of Medicine, Stanford, CA.
Columbia University Irving Medical Center, New York, NY.
Pediatr Emerg Care. 2022 Oct 1;38(10):517-520. doi: 10.1097/PEC.0000000000002676. Epub 2022 Mar 30.
Recent studies highlight the importance of physician readiness to practice beyond graduate training. The Accreditation Council for Graduate Medical Education mandates that pediatric emergency medicine (PEM) fellows be prepared for independent practice by allowing "progressive responsibility for patient care." Prior unpublished surveys of program directors (PDs) indicate variability in approaches to provide opportunities for more independent practice during fellowship training.
The aims of the study were to describe practices within PEM fellowship programs allowing fellows to work without direct supervision and to identify any barriers to independent practice in training.
DESIGN/METHODS: An anonymous electronic survey of PEM fellowship PDs was performed. Survey items were developed using an iterative modified Delphi process and pilot tested. Close-ended survey responses and demographic variables were summarized with descriptive statistics. Responses to open-ended survey items were reviewed and categorized by theme.
Seventy two of 84 PDs (88%) responded to the survey; however, not all surveys were completed. Of the 68 responses to whether fellows could work without direct supervision (as defined by the Accreditation Council for Graduate Medical Education) during some part of their training, 31 (45.6%) reported that fellows did have this opportunity. In most programs, clinical independence was conditional on specific measures including the number of clinical hours completed, milestone achievement, and approval by the clinical competency committee. Reported barriers to fellow practice without direct oversight included both regulatory and economic constraints.
Current training practices that provide PEM fellows with conditional clinical independence are variable. Future work should aim to determine best practices of entrustment, identify ideal transition points, and mitigate barriers to graduated responsibility.
最近的研究强调了医生准备在研究生培训之外执业的重要性。毕业后医学教育认证委员会要求儿科急诊医学（PEM）研究员通过允许“逐步承担患者护理责任”为独立实践做好准备。先前未发表的项目主任（PD）调查表明，在 fellowship 培训期间，提供更多独立实践机会的方法存在差异。
本研究旨在描述 PEM fellowship 计划中的实践，使研究员能够在没有直接监督的情况下工作，并确定培训中独立实践的任何障碍。
设计/方法：对 PEM fellowship PD 进行了匿名电子调查。使用迭代修改的 Delphi 过程开发调查项目，并进行了试点测试。使用描述性统计对封闭式调查回复和人口统计学变量进行总结。对开放式调查回复进行审查，并按主题进行分类。
84 名 PD 中有 72 名（88%）回应了调查，但并非所有调查都已完成。在 68 名对研究员在培训的某些阶段是否可以在没有直接监督的情况下（如毕业后医学教育认证委员会定义）工作的回复中，有 31 名（45.6%）报告说研究员确实有这个机会。在大多数计划中，临床独立性是有条件的，具体取决于包括临床小时数完成情况、里程碑成就和临床能力委员会批准等具体措施。报告的阻碍研究员在没有直接监督的情况下实践的障碍包括监管和经济限制。
目前为 PEM 研究员提供有条件临床独立性的培训实践存在差异。未来的工作应该旨在确定委托的最佳实践，确定理想的过渡点，并减轻对责任逐步增加的障碍。
