Abramson S, Stein J
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts 02114, USA.
Am J Phys Med Rehabil. 1998 May-Jun;77(3):235-42. doi: 10.1097/00002060-199805000-00008.
The purpose of this study was to determine the relationship between medical student knowledge and exposure to physiatry and the student's referral patterns for musculoskeletal disorders. Surveys were mailed to senior medical students at five United States medical schools across the country with a response rate of 26% (n=191). Five common musculoskeletal and neurologic disorders were presented as clinical vignettes and the student was asked to assume the role of a primary care physician and refer the patient to one of eight specialists listed. A section to assess the student's subjective overall knowledge and exposure to these fields was also included. Physiatrists received 27% of the referrals for evaluation and treatment of chronic low-back pain, 3% of the referrals for acute low-back pain, 10% of the referrals for carpal tunnel syndrome, 22% of the referrals for an industrial medicine injury, and 20% of the referrals for a sports medicine injury. The frequency of physiatry referrals for three of the five cases was significantly correlated (P < 0.05) with the student's overall knowledge of physical medicine and rehabilitation (PM&R). The presence of a department of PM&R at the student's school, however, did not have a significant impact on the rate of referrals. The results indicate that senior medical students referral patterns are strongly influenced by knowledge of PM&R. This suggests that focusing efforts on increasing this awareness may be an effective means of increasing referrals to physiatry in the future.
本研究的目的是确定医学生对物理医学与康复的知识掌握程度及接触情况与学生对肌肉骨骼疾病的转诊模式之间的关系。向美国全国五所医学院的高年级医学生邮寄了调查问卷，回复率为26%（n = 191）。以临床案例的形式呈现了五种常见的肌肉骨骼和神经系统疾病，并要求学生扮演初级保健医生的角色，将患者转诊至列出的八位专科医生之一。还包括一个评估学生对这些领域的主观总体知识和接触情况的部分。在慢性下腰痛的评估和治疗转诊中，物理医学与康复医生收到了27%的转诊；急性下腰痛转诊的3%；腕管综合征转诊的10%；工伤转诊的22%；运动损伤转诊的20%。在这五个案例中的三个案例中，物理医学与康复转诊的频率与学生对物理医学与康复（PM&R）的总体知识显著相关（P < 0.05）。然而，学生所在学校是否设有物理医学与康复系对转诊率没有显著影响。结果表明，高年级医学生的转诊模式受到物理医学与康复知识的强烈影响。这表明，未来集中精力提高这种认知可能是增加物理医学与康复转诊的有效手段。
