Gordon M J
Department of Family Medicine, University of Washington, Seattle.
Fam Med. 1993 Nov-Dec;25(10):637-45.
This paper describes a comprehensive, well-tested approach to managing residents with vexing noncognitive performance and attitudinal difficulties. Frustrations surrounding such cases often stem from inadequately defining and acknowledging the boundaries of faculty and resident prerogatives. Conceptual order is brought to these ill-structured problems by dividing nonroutine assessment into two cycles; a work-up cycle for suspected problems in which the resident is the primary decision maker, and a probation cycle for more serious issues in which faculty are the primary decision makers. By replacing adversarial positioning with a "let's find out" approach, the model encourages faculty to raise suspected issues early while supporting resident autonomy and professional responsibility. Finally, it recognizes the absolute discretion of faculty to judge trainee performance, to impose special requirements, or to terminate a resident's contract for cognitive or noncognitive deficiencies. Application of the model is illustrated through sample dialogues.
本文介绍了一种全面、经过充分测试的方法，用于管理那些存在令人困扰的非认知表现和态度问题的住院医师。围绕此类病例的挫败感往往源于对教员和住院医师特权界限的定义和认知不足。通过将非常规评估分为两个周期，为这些结构不良的问题带来了概念上的秩序；一个针对疑似问题的检查周期，在此周期中住院医师是主要决策者，以及一个针对更严重问题的试用期周期，在此周期中教员是主要决策者。通过用“让我们弄清楚”的方法取代对抗性定位，该模型鼓励教员尽早提出疑似问题，同时支持住院医师的自主权和职业责任。最后，它承认教员拥有绝对酌处权来评判实习生的表现、施加特殊要求，或因认知或非认知缺陷而终止住院医师的合同。通过示例对话说明了该模型的应用。
