Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment
Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment
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DOI：
10.1097/acm.0000000000002192
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发表时间：
2018-10-01
影响因子：
7.4
通讯作者：
Lang, Valerie J.
中科院分区：
文献类型：
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作者：
Cayea, Danelle;Tartaglia, Kim;Lang, Valerie J.
实践高价值护理（HVC）所需的临床技能是所有医学学科的核心。医学生实践习惯的形成较早，高职高专教育对医学生实践习惯的形成至关重要。本研究的目的是描述HVC的教学和评估在内科实习的状态，并确定需要额外的courses.MethodIn 2014年，在内科实习主任进行了年度调查121美国和加拿大的医学院。作者评估了调查中的一部分问题，询问实习主任对HVC教学的重要性，正式教学和评估的类型和数量，学生能力的实现，主题的优先顺序以及课程实施的障碍。描述性统计被用来总结响应，卡方检验被用来检查响应categors.ResultsThe总体响应率为77.7%（94/121）之间的关联。大多数人（85; 91.4%）同意医学院有责任在课程的所有阶段教授HVC。在答复者中，31人（32.9%）报告说，他们的课程有一些关于高价值观的正式指导，66人（70.2%）认为数量不足。最优先纳入的主题包括过度使用诊断测试和治疗，定义价值及其在临床推理中的应用，以及平衡利益和伤害。只有11（17.8%）评估学生的能力HVC.ConclusionsInternal医学实习主任报告说，HVC是不够的教学和评估在医学院，尽管相关的实践。开发可推广的课程材料，教师发展和专门的课程时间可以提高HVC教育。
PurposeThe clinical skills needed to practice high-value care (HVC) are core to all medical disciplines. Medical students form practice habits early, and HVC instruction is essential to this formation. The purpose of this study was to describe the state of HVC instruction and assessment in internal medicine clerkships and identify needs for additional curricula.MethodIn 2014, the Clerkship Directors in Internal Medicine conducted its annual survey of 121 U.S. and Canadian medical schools. The authors evaluated a subset of questions from that survey asking clerkship directors about the perceived importance of HVC instruction, type and amount of formal instruction and assessment, achievement of student competence, prioritization of topics, and barriers to curriculum implementation. Descriptive statistics were used to summarize responses, and chi-square tests were used to examine associations between response categories.ResultsThe overall response rate was 77.7% (94/121). The majority (85; 91.4%) agreed that medical schools have a responsibility to teach about HVC across all phases of the curriculum. Of respondents, 31 (32.9%) reported their curricula as having some formal instruction on HVC, and 66 (70.2%) felt the amount was inadequate. Highest-priority topics for inclusion included overuse of diagnostic tests and treatments, defining value and its application to clinical reasoning, and balancing benefit and harm. Only 11 (17.8%) assessed students' competence in HVC.ConclusionsInternal medicine clerkship directors reported that HVC is insufficiently taught and assessed in medical school, despite relevance to practice. Developing generalizable curricular materials, faculty development, and dedicated curricular time may enhance HVC education.