住院医师向住院医生角色转变过程中的挑战及改进建议策略。
Residents' Challenges in Transitioning to Residency and Recommended Strategies for Improvement.
作者信息
Perez Alejandro R, Boscardin Christy K, Pardo Manuel
机构信息
is a PGYA Resident Physician in the Department of Emergency Medicine at Loma Linda University Medical Center, Loma Linda, CA.
is a Professor; is a Professor in the Department of Anesthesia and Perioperative Care at the University of California, San Francisco, CA and is also in the Department of Medicine and Department of Anesthesia and Perioperative Care.
出版信息
J Educ Perioper Med. 2022 Jan 1;24(1):E679. doi: 10.46374/volxxiv_issue1_boscardin. eCollection 2022 Jan-Mar.
BACKGROUND
The transition from internship to residency can be a particularly stressful time for learners, adversely affecting residents' experience of training. Despite awareness of residents' stress during transitions, there is limited information available regarding how residents perceive these transitions or how they could be improved. We explored residents' accounts of the experience of transitioning from internship to residency to develop a better understanding of their challenges and recommended strategies for interventions.
METHODS
We conducted semistructured interviews with first-year anesthesia residents at the University of California, San Francisco. We conducted a thematic analysis through a general inductive approach on transcribed interviews.
RESULTS
Ten residents, evenly split among categorical and noncategorical residents, participated in the interviews. We identified seven challenges faced by residents during the transition, including cognitive load management, self-assessment and eliciting effective feedback, learning resource utilization, preoperative care planning and discussion, forming relationships with peers and faculty, and professional identity formation. Residents also recommended strategies to address these challenges, including early low-stake exposure to complex cases, standardized feedback structure, resource utilization guides, normalization of discussing errors with peers, and protected time for networking events.
CONCLUSION
Residents face multiple challenges at the personal, social, and structural levels during the transition. Their recommended strategies are actionable, including scaffolded learning opportunities with increasing difficulty, more standardized and structured communications around expectations and effective feedback, enhanced orientation through bootcamp, and integration of more formal and informal social networking opportunities to increase peer and faculty interaction.
背景
从实习医生过渡到住院医生对学习者来说可能是特别有压力的时期，会对住院医生的培训体验产生不利影响。尽管人们意识到住院医生在过渡期间的压力，但关于住院医生如何看待这些过渡以及如何改善这些过渡的信息有限。我们探讨了住院医生从实习医生过渡到住院医生的经历描述，以更好地了解他们面临的挑战，并推荐干预策略。
方法
我们对加利福尼亚大学旧金山分校的一年级麻醉科住院医生进行了半结构化访谈。我们通过一般归纳法对转录后的访谈进行了主题分析。
结果
10名住院医生参与了访谈，其中分类住院医生和非分类住院医生各占一半。我们确定了住院医生在过渡期间面临的七个挑战，包括认知负荷管理、自我评估和获取有效反馈、学习资源利用、术前护理计划和讨论、与同行和教员建立关系以及职业身份形成。住院医生还推荐了应对这些挑战的策略，包括早期低风险接触复杂病例、标准化反馈结构、资源利用指南、与同行讨论错误的常态化以及为社交活动留出专门时间。
结论
住院医生在过渡期间在个人、社会和结构层面面临多重挑战。他们推荐的策略是可行的，包括难度逐渐增加的支架式学习机会、围绕期望和有效反馈进行更标准化和结构化的沟通、通过新兵训练营加强入职培训，以及整合更多正式和非正式的社交网络机会，以增加同行和教员之间的互动。
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