Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
Dermatol Online J. 2023 Jun 15;29(3). doi: 10.5070/D329361425.
Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.
内科学与皮肤病学联合培训项目旨在提升复杂的医学皮肤病学和住院皮肤病学护理水平。一项先前的研究表明，与分类皮肤科住院医师相比，联合培训住院医师的项目满意度较低，但表示更希望从事学术职业。目前尚未报告培训后实践模式的后续数据。我们旨在描述与分类皮肤科住院医师培训相比，接受联合医学皮肤科住院医师培训的医生在住院医师项目满意度和实践模式方面的差异。我们调查了 2008 年至 2017 年期间，从六所机构毕业的联合医学皮肤科项目的医生及其同期或历史上有联合医学皮肤科培训的医生。55%的联合医学皮肤科医生和 41%的分类培训医生做出了回应。两组医生的实践模式相似。四分之一的联合医学皮肤科医生继续提供一般内科服务。分类培训医生对他们的培训满意度显著更高（P=0.03），并且对头颈（P=0.02）进行更多的切除术。联合培训毕业生在多学科护理方面有明显更大的信心（P=0.003），开具更多的生物制剂（P<0.001）和非生物免疫抑制剂（P=0.002），并自愿为社区中服务不足的患者提供更多服务（P=0.04）。尽管在总体实践模式方面，分类和联合培训毕业生之间的差异不大，但联合培训毕业生似乎对多学科护理更有信心，并且可能会照顾更多需要免疫抑制的医学上更复杂的患者。
