McAvoy Kathleen A, Gielissen Katherine A, Possick Jennifer D, Honiden Shyoko
Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and.
Grady Section, Division of General Internal Medicine, Emory School of Medicine, Atlanta, Georgia.
ATS Sch. 2024 Apr 19;5(2):286-301. doi: 10.34197/ats-scholar.2023-0130OC. eCollection 2024 Jun 1.
The Accreditation Council for Graduate Medical Education requires Pulmonary and Critical Care Medicine (PCCM) fellows spend a minimum of 7% of their time in the outpatient setting over 3 years of training. In a multi-institutional survey, only 47% of PCCM fellows rated their ambulatory training as adequate. Internal medicine residencies previously adopted the "x + y" scheduling model, which separates inpatient ("x") and outpatient ("y") rotations to provide focused ambulatory experiences, to address similar concerns.
To observe the effects of dedicated ambulatory blocks at a single academic PCCM fellowship on fellow exposure to outpatient pulmonary medicine, and on fellow and faculty perceptions of education.
In the 2021-2022 academic year, PCCM fellows of all class years in a single academic fellowship program in the northeast United States rotated through four 2-week ambulatory blocks that included longitudinal clinics, themed subspecialty clinics, and a dedicated educational half-day for small group learning. Before the intervention, fellow ambulatory clinics were scheduled longitudinally one-half day per week during inpatient and research blocks. Both fellows and faculty were surveyed before and after the intervention; fellows were also interviewed via focus groups at the conclusion of the intervention. The degree of subspecialty clinic exposure was compared before and after intervention.
There was an increase in the quantity and variety of pulmonary subspecialty clinics per fellow when compared with preintervention years ( < 0.01). After intervention, we observed increased fellow satisfaction with ambulatory education, perceived preparedness for independent practice, and satisfaction with subspecialty clinic exposure ( < 0.05). Faculty satisfaction with fellow ambulatory pulmonary education also increased ( < 0.05). Thematic analysis from focus groups highlighted focused topical learning, exposure to the breadth of pulmonary medicine, career development, interaction with engaged faculty experts, and enhanced interprofessional competence.
The ambulatory block structure provides a potential model to expand PCCM fellow outpatient pulmonary training through increased exposure to ambulatory pulmonology and dedicated ambulatory teaching. Important features of the ambulatory block structure include separation of outpatient clinics from competing responsibilities, expansion of fellow pulmonary exposure, opportunities for deliberate practice, and faculty engagement in fellow education.
毕业后医学教育认证委员会要求肺与重症医学（PCCM）专科住院医师在3年的培训期间，至少将7%的时间用于门诊工作。在一项多机构调查中，只有47%的PCCM专科住院医师认为他们的门诊培训足够。内科住院医师培训项目此前采用了“x + y”排班模式，即将住院（“x”）和门诊（“y”）轮转分开，以提供集中的门诊体验，来解决类似的问题。
观察在单一学术性PCCM专科住院医师培训项目中设置专门的门诊模块对专科住院医师接触门诊肺科医学的影响，以及对专科住院医师和教员教育认知的影响。
在2021 - 2022学年，美国东北部一个单一学术专科住院医师培训项目的各年级PCCM专科住院医师轮转通过四个为期2周的门诊模块，其中包括纵向门诊、主题亚专科门诊，以及专门用于小组学习的教育半天。在干预前，专科住院医师门诊安排在住院和研究模块期间每周纵向半天。在干预前后对专科住院医师和教员都进行了调查；在干预结束时还通过焦点小组对专科住院医师进行了访谈。比较了干预前后亚专科门诊接触程度。
与干预前几年相比，每名专科住院医师的肺科亚专科门诊数量和种类都有所增加（<0.01）。干预后，我们观察到专科住院医师对门诊教育的满意度提高，对独立执业的准备程度提高，以及对亚专科门诊接触的满意度提高（<0.05）。教员对专科住院医师门诊肺科教育的满意度也提高了（<0.05）。焦点小组的主题分析突出了重点专题学习、对肺科医学广度的接触、职业发展、与敬业的教员专家互动以及增强的跨专业能力。
门诊模块结构提供了一个潜在的模式，通过增加对门诊肺科的接触和专门的门诊教学来扩大PCCM专科住院医师的门诊肺科培训。门诊模块结构的重要特征包括将门诊诊所与其他竞争职责分开、扩大专科住院医师对肺科的接触、刻意练习的机会以及教员参与专科住院医师教育。
