Ashton C M
Houston Center for Quality of Care and Utilization Studies, Department of Veterans Affairs Medical Center, TX 77030.
Acad Med. 1993 Nov;68(11):823-4. doi: 10.1097/00001888-199311000-00003.
The author maintains that residents should be as actively engaged in the evaluation and improvement of the inpatient and ambulatory care they deliver as staff physicians are, and that to exclude them from their departments' formal quality assessment and assurance program wastes valuable opportunities to train them and to improve patient care. For example, residents can benefit from process-of-care reviews, which help teach them the standards of adequate medical care and motivate them to improve the care they give. Residents can also benefit from participating in the quality assessment process itself; this will help develop their clinical and analytic skills, hone their skills in searching and critiquing the medical literature, and help them understand the links between the processes and outcomes of care. In addition, systematic, criteria-based reviews of residents' clinical competence in the diagnosis and treatment of common medical conditions can help attending physicians and residency directors evaluate the residents' abilities. And finally, hospitals benefit from the involvement of housestaff in the quality improvement program, since housestaff often have more insight than staff physicians or administrators into aspects of the physical plant or organizational structure that impair clinicians' ability to provide good care. The author gives examples for each of the preceding statements, and concludes by saying that when residents are treated as if they are "invisible" in quality assessment programs, the program staff is in some measure abdicating its responsibility for the residents' education and for the well-being of the program's current and the residents' future patients.
作者认为，住院医师应像在职医师一样积极参与其所提供的住院和门诊护理的评估与改进，将他们排除在科室的正式质量评估和保证计划之外，会浪费培训他们以及改善患者护理的宝贵机会。例如，住院医师能从护理过程审查中受益，这有助于教会他们充分医疗护理的标准，并激励他们改进所提供的护理。住院医师参与质量评估过程本身也能受益；这将有助于培养他们的临床和分析技能，磨练他们检索和评判医学文献的技能，并帮助他们理解护理过程与结果之间的联系。此外，对住院医师在常见疾病诊断和治疗方面的临床能力进行系统的、基于标准的审查，有助于主治医师和住院医师培训主任评估住院医师的能力。最后，住院医师参与质量改进计划对医院也有益，因为住院医师通常比在职医师或管理人员更能洞察影响临床医生提供优质护理能力的物理设施或组织结构方面的问题。作者为上述每一项陈述都给出了例子，并总结说，在质量评估计划中若将住院医师视为“隐形人”，那么计划工作人员在一定程度上就放弃了对住院医师教育以及对计划当前患者和住院医师未来患者福祉的责任。
