Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.
BMC Med Educ. 2022 Sep 9;22(1):666. doi: 10.1186/s12909-022-03730-y.
Patient care ownership (PCO) is crucial to enhancing accountability, clinical skills, and medical care quality among medical trainees. Despite its relevance, there is limited information on the association of personal or environmental factors with PCO, and thus, authors aimed to explore this association.
In 2021, the authors conducted a multicentered cross-sectional study in 25 hospitals across Japan. PCO was assessed by using the Japanese version of the PCO Scale (J-PCOS). To examine the association between personal (level of training, gender, and department) or environmental factors (hospital size, hospital type, medical care system, number of team members, number of patients receiving care, mean working hours per week, number of off-hour calls per month, and perceived level of the workplace as a learning environment) and PCO after adjusting for clustering within hospitals, the authors employed a linear mixed-effects model.
The analysis included 401 trainees. After adjusting for clustering within hospitals, it was confirmed that the senior residents had significantly better J-PCOS total scores (adjusted mean difference: 8.64, 95% confidence interval [CI]: 6.18-11.09) than the junior residents and the perceived level of the workplace as a learning environment had a positive association with J-PCOS total scores (adjusted mean difference per point on a global rating of 0-10 points: 1.39, 95% CI: 0.88-1.90). Trainees who received calls after duty hours had significantly higher J-PCOS total scores than those who did not (adjusted mean difference: 2.51, 95% CI: 0.17-4.85). There was no clear trend in the association between working hours and PCO.
Seniority and the perceived level of the workplace as a learning environment are associated with PCO. An approach that establishes a supportive learning environment and offers trainees a reasonable amount of autonomy may be beneficial in fostering PCO among trainees. The study findings will serve as a useful reference for designing an effective postgraduate clinical training program for PCO development.
患者照护所有权（PCO）对于提高医学受训者的问责制、临床技能和医疗质量至关重要。尽管它很重要，但关于个人或环境因素与 PCO 的关联的信息有限，因此，作者旨在探讨这种关联。
2021 年，作者在日本 25 家医院进行了一项多中心横断面研究。使用日本版 PCO 量表（J-PCOS）评估 PCO。为了研究个人（培训水平、性别和科室）或环境因素（医院规模、医院类型、医疗保健系统、团队成员人数、接受照护的患者人数、每周平均工作时间、每月非工作时间呼叫次数、以及对工作场所作为学习环境的感知水平）与 PCO 之间的关联，作者在调整了医院内的聚类后，采用了线性混合效应模型。
该分析纳入了 401 名受训者。在调整了医院内的聚类后，确认了高级住院医师的 J-PCOS 总分明显优于初级住院医师（调整后的平均差异：8.64，95%置信区间[CI]：6.18-11.09），并且对工作场所作为学习环境的感知水平与 J-PCOS 总分呈正相关（在 0-10 分的全球评分上每增加 1 分的调整平均差异：1.39，95%CI：0.88-1.90）。在值班后接到电话的受训者的 J-PCOS 总分明显高于未接到电话的受训者（调整后的平均差异：2.51，95%CI：0.17-4.85）。工作时间与 PCO 之间的关联没有明显的趋势。
资历和对工作场所作为学习环境的感知水平与 PCO 相关。建立支持性学习环境并为受训者提供合理自主权的方法可能有助于培养受训者的 PCO。研究结果将为设计有效的研究生临床培训计划以促进 PCO 发展提供有用的参考。
