Garfunkel L C, Byrd R S, McConnochie K M, Auinger P
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Children's Hospital at Strong, New York, USA.
Pediatrics. 1998 Jan;101(1 Pt 1):37-42. doi: 10.1542/peds.101.1.37.
To assess resident, patient, and family continuity.
Continuity clinic is the principal longitudinal primary care experience for pediatric residents. Although it has been a recommendation of the Residency Review Committee for pediatric training for more than 10 years and has been a requirement of the Accreditation Council of Graduate Medical Education since 1989, the extent to which continuity is achieved in this setting has not been reported.
Nine years (1984-1993) of residents' continuity clinic experience in a community hospital affiliate of a university training program were reviewed. Continuity was defined by recurring visits between the same patient/provider pair. The analysis from 57 different residents includes 48 intern (R1) years, 45 level two (R2) years, and 40 level three (R3) years; 32 of these residents completed all 3 years of training (3-year cohort) in the program during the study period. Observations included 89 952 visits by 11 009 patients in 7130 families. Continuity was determined for the resident, patient, and family.
Residents saw an annual average of 93, 136, and 144 visits as R1s, R2s, and R3s. Residents saw 60% of their patients fewer than 3 times and nearly 40% only once. In the final year for those in the 3-year cohort, residents saw an average of 149 visits; 53% of the time these R3s had seen their patients once or twice over 3 years. Thirty percent of the patients never saw their primary care physician (PCP) and 72% of patients had fewer than 3 visits with their PCP. One quarter of the families never saw their continuity resident, and 62% saw their continuity resident fewer than 3 times.
These data demonstrate a remarkable lack of both resident and patient continuity in the principal clinical activity affording longitudinal primary care experiences during residency training. If more continuity is essential for both primary care of patients and education in general pediatrics, change in the structure of continuity experience is required.
评估住院医师、患者及家庭的连续性。
连续性门诊是儿科住院医师主要的纵向初级保健体验。尽管这是住院医师评审委员会对儿科培训的一项建议已有10多年，且自1989年以来一直是毕业后医学教育认证委员会的一项要求，但在这种情况下实现连续性的程度尚未见报道。
回顾了一所大学培训项目的社区医院附属机构9年（1984 - 1993年）住院医师的连续性门诊经历。连续性定义为同一患者/提供者对之间的反复就诊。对57名不同住院医师的分析包括48个实习医师（R1）年、45个二级（R2）年和40个三级（R3）年；其中32名住院医师在研究期间完成了该项目的全部3年培训（3年队列）。观察包括7130个家庭中11009名患者的89952次就诊。确定了住院医师、患者及家庭的连续性。
作为R1、R2和R3，住院医师每年平均就诊次数分别为93次、136次和144次。住院医师60%的患者就诊次数少于3次，近40%的患者仅就诊1次。在3年队列中那些住院医师的最后一年，他们平均就诊149次；这些R3中有53%的时间在3年里仅见过他们的患者一两次。30%的患者从未见过他们的初级保健医生（PCP），72%的患者与PCP的就诊次数少于3次。四分之一的家庭从未见过他们的连续性住院医师，62%的家庭见到他们的连续性住院医师少于3次。
这些数据表明，在住院医师培训期间提供纵向初级保健体验的主要临床活动中，住院医师和患者的连续性都明显不足。如果更多的连续性对于患者的初级保健和普通儿科学教育都至关重要，那么就需要改变连续性体验的结构。
