The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education.
The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education.
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DOI：
10.1177/1358863x18767753
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发表时间：
2018-08
期刊：
影响因子：
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通讯作者：
Cameron SJ
中科院分区：
文献类型：
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作者：
Elbadawi A;Wright C;Patel D;Chen YL;Mazzillo J;Cameron P;Barnes GD;Cameron SJ
肺栓塞反应小组（PERT）模式对实习医生教育和高危肺栓塞（PE）管理自主权的影响尚不清楚。PERT实施1年后，进行了居民和研究员问卷调查。共有122名医生接受了调查，73名医生做出了回应。即使在与PERT咨询服务进行了12个月的互动，并接受了高风险PE管理的正式指导后，51%和49%的受访者分别低估了次大规模和大规模PE的真实3个月死亡率，44%的受访者不知道PE患者的常见体检结果。在PERT实施前后进行比较，医生认为在识别（p<0.001）和管理（p=0.003）次大规模/大规模PE方面的信心增强，通过全身溶栓适当治疗患者的信心增强（p=0.04），并增加了对全身溶栓和手术取栓术适应症的了解（分别为p=0.043和p<0.001）。受访者自我报告增加了对高风险PE病理生理学的了解（77%），并认为多学科团队可以改善高风险PE患者的护理（89%）。71%的受访者赞成广泛实施PERT，类似于急性心肌梗死团队。总体而言，实习医生在一个大型机构认为增强的教育经验，同时管理PE PERT实施后，相信团队的概念是更好的病人护理。
The impact of the Pulmonary Embolism Response Team (PERT) model on trainee physician education and autonomy over the management of high risk pulmonary embolism (PE) is unknown. A resident and fellow questionnaire was administered 1 year after PERT implementation. A total of 122 physicians were surveyed, and 73 responded. Even after 12 months of interacting with the PERT consultative service, and having formal instruction in high risk PE management, 51% and 49% of respondents underestimated the true 3-month mortality for sub-massive and massive PE, respectively, and 44% were unaware of a common physical exam finding in patients with PE. Comparing before and after PERT implementation, physicians perceived enhanced confidence in identifying (p<0.001), and managing (p=0.003) sub-massive/massive PE, enhanced confidence in treating patients appropriately with systemic thrombolysis (p=0.04), and increased knowledge of indications for systemic thrombolysis and surgical embolectomy (p=0.043 and p<0.001, respectively). Respondents self-reported an increased fund of knowledge of high risk PE pathophysiology (77%), and the perception that a multi-disciplinary team improves the care of patients with high risk PE (89%). Seventy-one percent of respondents favored broad implementation of a PERT similar to an acute myocardial infarction team. Overall, trainee physicians at a large institution perceived an enhanced educational experience while managing PE following PERT implementation, believing the team concept is better for patient care.