Effect of a physical examination teaching program on the behavior of medical residents
Effect of a physical examination teaching program on the behavior of medical residents
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DOI：
10.1111/j.1525-1497.2005.0159.x
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发表时间：
2005-08-01
影响因子：
5.7
通讯作者：
Katz, JT
中科院分区：
文献类型：
--
作者：
McMahon, GT;Marina, O;Katz, JT
背景：对体检作为诊断辅助手段的依赖正在下降。目的：确定教育计划是否可以增加住院医师体检的使用率。设计和参与者：在一家大型学术教学医院为 47 名二年级和三年级住院医师举办了一系列教育讲习班。测量：实习生和学生报告了讲习班之前和之后六个月内住院医师在晨查房时进行临床检查的频率和深度。使用混合模型比较研讨会前后的行为。结果：总共返回 374 份报告（77% 的答复）。在调整服务类型和观察员后，参加课程的住院医师的体检表现在统计上显着提高了 23% (P =. 02)。住院医师显着增加了查房检查的患者比例（绝对增加 11%，P =. 002），但没有增加检查的深度。变化最大的是普通医疗队，其中体检频率最低。住院医生向实习生（分别为每两周 2.8 次和 1.1 次）和医学生（每两周分别为 5.9 次和 2.8 次）进行的医疗团队教学和反馈活动仍然很少。 结论：技能改进计划可以显着增加体检频率，但教学和反馈活动仍然是零星且不频繁的。
CONTEXT: The reliance on physical examination as a diagnostic aid is in decline.OBJECTIVE: To determine whether an educational program can increase the use of physical examination by medical residents.DESIGN AND PARTICIPANTS: A series of educational workshops were provided to 47 second- and third-year medical residents at a large academic teaching hospital.MEASUREMENTS: Interns and students reported the frequency and depth of clinical examination performance on morning rounds by their residents before and up to six months after the workshops. Behavior before and after the workshops was compared using a mixed model.RESULTS: A total of 374 reports were returned (77% response). After adjusting for the type of service and observer, there was a statistically significant 23% increase (P =. 02) in the performance of physical examination among residents who attended the course. Residents significantly increased the fraction of patients they examined on rounds ( absolute increase 11%, P =. 002) but did not increase the depth of their examination. The change was greatest on general medical teams, among whom the performance of physical examination had been least frequent. Teaching and feedback events on medicine teams by residents to their interns (2.8 and 1.1 events per 2 weeks, respectively) and medical students (5.9 and 2.8 events per 2 weeks, respectively) remained infrequent.CONCLUSIONS: A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.