美国一所学术医疗中心中医疗保健的形式合理化对医师临床教学的影响。

The impact of the formal rationalization of healthcare on physician clinical teaching in a United States academic medical center.

作者信息

Rogers David A, Meese Katherine A, Cain Cindy L

机构信息

Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Office of Wellness KCPD 509, 2720 2nd Ave South, Birmingham, AL, 35294-2129, USA.

UAB (University of Alabama at Birmingham) Medicine Office of Wellness, Birmingham, AL, USA.

出版信息

BMC Med Educ. 2025 Jul 1;25(1):867. doi: 10.1186/s12909-025-07467-2.

DOI:10.1186/s12909-025-07467-2

PMID:40597927

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12210602/

Abstract

BACKGROUND

Formal rationalization is the process whereby an organization achieves the greatest efficiency through the control of work and is occurring in the United States as an effort to control healthcare costs. This study aimed to explore the McDonaldization thesis's impact, a contemporary form of formal rationalization, on the academic physicians teaching in a clinical setting where patient care is also being delivered.

METHODS

Focus groups of physicians from a single academic medical in the Southeast United States were conducted. Eighteen physicians participated in four groups, representing seven specialties. Session transcripts and field notes served as the data set analyzed.

RESULTS

Four major categories of impact on physicians who teaching in the clinical setting were identified: (1) they hold the view that rationalizing processes will diminish positive features of practicing medicine for learners (2) the compensation plan emphasizes clinical productivity and efficiency at the expense of time to teach (3) the appropriate use of patient cares algorithms embedded in the electronic health care system is an emerging learning need that they are struggling to meet (4) this group of academic physicians is adapting in a number of ways to accommodate to these changes.

CONCLUSION

Physicians teaching in clinical settings has changed in response to the continued formal rationalization of healthcare. Physicians in this study expressed concern about the immediate and long-term consequences of these changes but also described their strategies for adapting. Despite their distress, they are adapting to try to preserve and enhance their teaching efforts despite the increasing demands of patient care. Our results support the previous recommendation of teaching job crafting and suggest the potential value of team job crafting. However, these group-level approaches must be accompanied by systems changes that address perception of inequity of recognition between clinical work and teaching held by these physicians.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

形式合理化是一个组织通过控制工作来实现最高效率的过程，在美国，这一过程正作为控制医疗成本的一种努力而出现。本研究旨在探讨形式合理化的当代形式——麦当劳化理论，对在提供患者护理的临床环境中教学的学术医生的影响。

方法

在美国东南部的一家学术医疗中心对医生进行了焦点小组访谈。18名医生参加了4个小组，代表7个专业。访谈记录和实地笔记作为分析的数据集。

结果

确定了对在临床环境中教学的医生产生影响的四大类：（1）他们认为合理化过程会削弱医学生行医的积极特征；（2）薪酬计划强调临床生产力和效率，却以教学时间为代价；（3）正确使用电子医疗系统中嵌入的患者护理算法是他们难以满足的新出现的学习需求；（4）这群学术医生正在以多种方式进行调整以适应这些变化。

结论

临床环境中的教学医生已因医疗保健持续的形式合理化而发生了变化。本研究中的医生表达了对这些变化的近期和长期后果的担忧，但也描述了他们的适应策略。尽管他们感到苦恼，但尽管患者护理需求不断增加，他们仍在努力适应，以试图维持和加强他们的教学工作。我们的结果支持了之前关于教学工作重塑的建议，并表明了团队工作重塑的潜在价值。然而，这些团体层面的方法必须伴随着系统变革，以解决这些医生对临床工作和教学之间认可不平等的看法。