Steinert Y, Levitt C
Herzl Family Practice Center, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec.
Fam Med. 1993 Nov-Dec;25(10):627-32.
Clinical teachers often work with residents whom they view as "difficult." For some, it is a knowledge deficit that first alerts them to a problem; for others, it is an attitudinal problem or distressing behavior. The goal of this article is to describe a framework for identifying residents' problems and to outline strategies for intervention. When teachers first suspect a problem, they should try to define the resident's troubling behavior, assess other contributing factors, and evaluate the potential impact of the problem. Following this initial process, teachers should try to confirm their suspicions by determining the resident's perception of the problem, relevant life history, and perceived strengths and weaknesses. They should also examine their own strengths and weaknesses and obtain other teachers' views of the perceived difficulty. In designing an intervention, teachers should carefully define the goal and time frame of the intervention, determine how the problem will be addressed, and decide how the intervention will be documented and evaluated. Although residents' difficulties are often seen as residing within the resident alone, teacher and systems factors must be considered, and the resident should be involved in every step of the process.
临床教师常常要与他们认为“难搞”的住院医师共事。对一些教师来说，首先让他们警觉到问题的是知识欠缺；对另一些教师来说，则是态度问题或令人苦恼的行为。本文的目的是描述一个识别住院医师问题的框架，并概述干预策略。当教师首次怀疑有问题时，他们应尝试界定住院医师令人烦恼的行为，评估其他促成因素，并评估该问题的潜在影响。在这个初始过程之后，教师应通过确定住院医师对问题的看法、相关生活史以及感知到的优点和缺点来尝试证实他们的怀疑。他们还应审视自身的优点和缺点，并获取其他教师对所察觉到困难的看法。在设计干预措施时，教师应仔细界定干预的目标和时间框架，确定将如何解决问题，并决定将如何记录和评估干预措施。尽管住院医师的困难通常被视为仅存在于住院医师自身，但必须考虑教师和系统因素，并且住院医师应参与到这个过程的每一步。
