Barton L L, Rice S A, Wells S J, Friedman A D
Department of Pediatrics, University of Arizona, Tucson, USA.
Clin Pediatr (Phila). 1997 Oct;36(10):581-3. doi: 10.1177/000992289703601005.
We examined and contrasted morning reports at two hospitals, university and community, that have a pediatric residency program. Patient diagnoses assigned at morning report were compared with final diagnoses to assess disease categories discussed and the value of including outpatient follow-up in this educational forum. Data were obtained during morning reports for 6 months by chief residents at university and private community hospitals. Pertinent history, physical examination, and laboratory and radiologic findings were recorded and were assigned a tentative morning report diagnosis based on morning report discussion. Cases were then reviewed at discharge and at 6 months to determine final diagnoses. At the university hospital, 58% of the cases were undiagnosed before presentation at morning report. Of those cases, 23% were assigned a diagnosis at morning report that differed from the final diagnosis. Similarly, at the private community hospital, 28% of cases were undiagnosed before presentation at morning report. Of those cases, 73% were assigned a diagnosis that differed from the final diagnosis. We conclude that the provision of follow-up at morning report is important for maximizing resident education.
我们对设有儿科住院医师培训项目的一所大学医院和一所社区医院的早间病例讨论进行了检查和对比。将早间病例讨论时给出的患者诊断与最终诊断进行比较,以评估所讨论的疾病类别,以及在这个教育论坛中纳入门诊随访的价值。大学医院和私立社区医院的住院总医师在6个月的早间病例讨论期间收集数据。记录相关病史、体格检查以及实验室和影像学检查结果,并根据早间病例讨论情况给出初步的早间病例讨论诊断。然后在出院时和6个月时复查病例以确定最终诊断。在大学医院,58%的病例在早间病例讨论前未得到诊断。在这些病例中,23%在早间病例讨论时得到的诊断与最终诊断不同。同样,在私立社区医院,28%的病例在早间病例讨论前未得到诊断。在这些病例中,73%得到的诊断与最终诊断不同。我们得出结论,在早间病例讨论时提供随访对于最大限度地提高住院医师教育水平很重要。