优秀主治医生榜样的特质。

Attributes of excellent attending-physician role models.

作者信息

Wright S M, Kern D E, Kolodner K, Howard D M, Brancati F L

机构信息

Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA.

出版信息

N Engl J Med. 1998 Dec 31;339(27):1986-93. doi: 10.1056/NEJM199812313392706.

DOI:10.1056/NEJM199812313392706

PMID:9869671

Abstract

BACKGROUND

Although effective role models are important in medical education, little is known about the characteristics of physicians who serve as excellent clinical role models. We therefore conducted a case-control study to identify attributes that distinguish such physicians from their colleagues.

METHODS

We asked members of the internal-medicine house staff at four teaching hospitals to name physicians whom they considered to be excellent role models. A total of 165 physicians named by one or more house-staff members were classified as excellent role models (these served as the case physicians in our study). A questionnaire was sent to them as well as to 246 physicians who had residency-level teaching responsibilities but who were not named (controls). Of these 411 physicians, 341 (83 percent) completed questionnaires while unaware of their case-control status.

RESULTS

Of the 341 attending physicians who responded, 144 (42 percent) had been identified as excellent role models. Having greater assigned teaching responsibilities was strongly associated with being identified as an excellent role model. In the multivariate analysis, five attributes were independently associated with being named as an excellent role model: spending more than 25 percent of one's time teaching (odds ratio, 5.12; 95 percent confidence interval, 1.81 to 14.47), spending 25 or more hours per week teaching and conducting rounds when serving as an attending physician (odds ratio, 2.48; 95 percent confidence interval, 1.15 to 5.37), stressing the importance of the doctor-patient relationship in one's teaching (odds ratio, 2.58; 95 percent confidence interval, 1.03 to 6.43), teaching the psychosocial aspects of medicine (odds ratio, 2.31; 95 percent confidence interval, 1.23 to 4.35), and having served as a chief resident (odds ratio, 2.07; 95 percent confidence interval, 1.07 to 3.98).

CONCLUSIONS

These data suggest that many of the attributes associated with being an excellent role model are related to skills that can be acquired and to modifiable behavior.

摘要

背景

尽管有效的榜样在医学教育中很重要，但对于那些堪称优秀临床榜样的医生的特征却知之甚少。因此，我们开展了一项病例对照研究，以确定能将这类医生与其同事区分开来的特质。

方法

我们让四家教学医院的内科住院医师说出他们认为堪称优秀榜样的医生。共有165位被一名或多名住院医师提名的医生被归类为优秀榜样（这些医生在我们的研究中作为病例组医生）。我们向他们以及246位承担住院医师教学职责但未被提名的医生（对照组）发放了问卷。在这411位医生中，341位（83%）在不知自己病例对照身份的情况下完成了问卷。

结果

在回复问卷的341位主治医师中，144位（42%）被认定为优秀榜样。承担更多既定教学职责与被认定为优秀榜样密切相关。在多变量分析中，有五个特质与被评为优秀榜样独立相关：将超过25%的时间用于教学（比值比，5.12；95%置信区间，1.81至14.47），担任主治医师时每周花25小时或更多时间教学和查房（比值比，2.48；95%置信区间，1.15至5.37），在教学中强调医患关系的重要性（比值比，2.58；95%置信区间，1.03至6.43），讲授医学的社会心理方面（比值比，2.31；95%置信区间，1.23至4.35），以及曾担任过总住院医师（比值比，2.07；95%置信区间，1.07至3.98）。