Zuo Stephanie W, Hueppchen Nancy A, Salas Rachel Marie E, Gamaldo Charlene E, Patel Silka
Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center-Magee Women's Hospital, Pittsburgh, PA.
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
PRiMER. 2022 Jul 25;6:21. doi: 10.22454/PRiMER.2022.611785. eCollection 2022.
We sought to explore whether obstetrics and gynecology (Ob-Gyn) ambulatory clinic preceptors can maintain their clinical productivity with a learner (medical student) present.
We studied the productivity of five exemplary Ob-Gyn faculty over the 2016-2017 academic year. We used paired two-tailed tests to compare physician productivity with and without a student. Faculty were interviewed and qualitative analyses were performed on faculty interview data to identify themes used to create sample best-practice workflows for student involvement in the clinic.
Three faculty had significant increases in relative value units (RVUs) per clinic half-day when a medical student was present (11%-31% increase, <.05). Four faculty had average increases in net charges billed per clinic half-day ranging from $172.39 to $343.14. One faculty preceptor had a decrease in RVUs and charges billed when a student was present, which was not statistically significant. Themes derived from faculty interviews regarding their incorporation of medical students in the clinic included setting expectations, allowing students to assist with clinic workflow, note-writing, and efficient use of time and clinic space. In an iterative feedback process, we developed ideal workflow models for student involvement during clinic visits with and without a procedure.
This mixed-methods pilot study suggests that medical students do not impede clinician productivity when utilized effectively in the outpatient setting. Further contemporary research is needed to assess the impact of learners on ambulatory clinician productivity in light of Medicare policy changes and modifications in medical education due to the COVID-19 pandemic.
我们试图探讨妇产科门诊带教老师在有学生(医学生)在场的情况下能否保持其临床工作效率。
我们研究了2016 - 2017学年五位优秀妇产科教员的工作效率。我们使用配对双尾检验来比较有学生和没有学生时医生的工作效率。对教员进行了访谈,并对教员访谈数据进行了定性分析,以确定用于创建医学生参与门诊的最佳实践工作流程样本的主题。
三名教员在有医学生在场时,每半天门诊的相对价值单位(RVU)有显著增加(增加11% - 31%,P <.05)。四名教员每半天门诊的净收费平均增加,范围从172.39美元到343.14美元。一名带教老师在有学生在场时RVU和收费有所下降,但无统计学意义。教员访谈中得出的关于他们在门诊中纳入医学生的主题包括设定期望、让学生协助门诊工作流程、记录书写以及高效利用时间和门诊空间。在一个迭代反馈过程中,我们开发了有操作和无操作的门诊就诊期间医学生参与的理想工作流程模型。
这项混合方法的试点研究表明,医学生在门诊环境中得到有效利用时不会妨碍临床医生的工作效率。鉴于医疗保险政策的变化以及由于COVID - 19大流行导致的医学教育变革,需要进一步的当代研究来评估学习者对门诊临床医生工作效率的影响。