Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2020-001101.
The Masters in Internal Medicine at the Makerere University College of Health Sciences is based on a semester system with a blend of lectures and clinical work. The programme runs for 3 years with didactic lectures set mostly for mornings and clinical care thereafter. Anecdotal reports from attending physicians in the department highlighted clinical work time interruption by didactic lectures which was thought to limit postgraduate (PG) students' clinical work time. We set out to evaluate the clinical learning environment and explore avenues to optimise clinical exposure time.
Baseline data in form of time logs documenting first-year PG activities was collected by intern doctors without the awareness of the PGs. In addition, a PG and attending physician survey on PG ward performance was carried out. These data informed a root cause analysis from which an intervention to change the mode of lecture delivery from daily lecturers across the semester to a set of block lectures was undertaken. Postimplementation time logs and survey data were compared with the pre-intervention data.
Post-intervention, during a period of 50 ward round observations, PGs missed 3/50 (6%) ward rounds as compared with 10/50 (20%) pre-intervention. PGs arrived on wards before attending physicians 18/24 (75%) times post-intervention and on average had 59 min to prepare for ward rounds as compared with 5/26 (19.2%) times and 30 min, respectively, pre-intervention. Both PGs and physicians believed PGs had enough time for patient care post-intervention (17/17 (100%) vs 4/17 (23.5%) and 7/8 (87.5%) vs 2/8 (25%)), respectively.
The baseline data collected confirmed the anecdotal reports and a change to a block week lecture system led to improvements in PGs' clinical work time and both resident and physician approvals of PG clinical work.
马凯雷雷大学健康科学学院的内科硕士课程基于学期制，结合讲座和临床工作。该课程为期 3 年，上午主要安排理论课，之后进行临床护理。该系主治医生的传闻报告强调了理论课打断临床工作的情况，这被认为限制了研究生（PG）的临床工作时间。我们着手评估临床学习环境，并探索优化临床实习时间的途径。
第一年 PG 活动的时间日志记录了基线数据，由实习医生在不知道 PG 学生的情况下收集。此外，还对 PG 和主治医生进行了 PG 病房表现调查。这些数据为根本原因分析提供了信息，在此基础上，我们采取了一项干预措施，将讲座方式从整个学期的日常讲师授课改为一系列集中授课。实施后，我们比较了时间日志和调查数据与干预前的数据。
干预后，在 50 次病房查房观察期间，PG 学生错过了 3/50（6%）次查房，而干预前为 10/50（20%）次。PG 学生在主治医生查房前到达病房的次数为 18/24（75%）次，平均有 59 分钟准备查房，而干预前分别为 5/26（19.2%）次和 30 分钟。PG 和医生都认为干预后 PG 有足够的时间进行患者护理（17/17（100%）对 4/17（23.5%）和 7/8（87.5%）对 2/8（25%））。
收集的基线数据证实了传闻报告，将讲座系统改为集中周制，提高了 PG 的临床工作时间，主治医生和医生都认可 PG 的临床工作。
