Scheid D, Logue E, Gilchrist V J, Gillanders W R, Miller R S, Iverson D, Oprandi A M, Weldy D L
Akron General Medical Center, Ohio, USA.
Fam Med. 1995 Sep;27(8):519-24.
In academic family practice centers, the distribution of patients between faculty and residents influences the educational milieu. The medical literature has rarely addressed the differential case mix within the ambulatory medical educational setting. The goal of this study was to compare the characteristics of patient visits to resident and faculty physicians in seven community-based, university-affiliated family practice programs.
Using the National Ambulatory Care Survey instrument and protocol, 98 faculty and resident physicians recorded their ambulatory patient visits for one randomly selected week between July 1991 and June 1992 (n = 1,498).
Patients of resident physicians were younger, more likely to be nonwhite (21.7% vs 9.8%, P < .001), and more likely to be reimbursed by Medicaid (34.2% vs 14.3%, P < .001) than patients of faculty physicians. Despite these patient differences, the spectrum of clinical problems was similar. There were minimal differences in the delivery of diagnostic services and therapeutic services.
The patients seen by residents and faculty differ in important demographic characteristics. These differences could adversely affect the education of resident physicians. Academic family practice centers should actively monitor the age/gender/payment profile of resident and faculty patient panels and assign patients to achieve a desirable case mix for resident education. The differential racial distribution of faculty and resident visits suggests an unidentified systematic bias in patient assignment that warrants further investigation.
在学术性家庭医疗中心，患者在教员和住院医师之间的分配会影响教育环境。医学文献很少涉及门诊医学教育环境中的病例组合差异。本研究的目的是比较七个社区型、大学附属家庭医疗项目中住院医师和教员医生的患者就诊特征。
使用国家门诊医疗调查工具和方案，98名教员和住院医师记录了他们在1991年7月至1992年6月期间随机选择的一周内的门诊患者就诊情况（n = 1498）。
与教员医生的患者相比，住院医师的患者更年轻，非白人比例更高（21.7%对9.8%，P <.001），由医疗补助计划报销的可能性更大（34.2%对14.3%，P <.001）。尽管患者存在这些差异，但临床问题的范围相似。诊断服务和治疗服务的提供方面差异极小。
住院医师和教员所诊治的患者在重要人口统计学特征方面存在差异。这些差异可能会对住院医师的教育产生不利影响。学术性家庭医疗中心应积极监测住院医师和教员患者群体的年龄/性别/支付情况，并分配患者以实现理想的住院医师教育病例组合。教员和住院医师就诊的种族分布差异表明在患者分配中存在未识别的系统性偏差，值得进一步调查。
