Perceived preparedness to provide preventive counseling - Reports of graduating primary care residents at academic health centers
Perceived preparedness to provide preventive counseling - Reports of graduating primary care residents at academic health centers
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DOI：
10.1111/j.1525-1497.2005.0024.x
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发表时间：
2005-05-01
影响因子：
5.7
通讯作者：
Rigotti, NA
中科院分区：
文献类型：
--
作者：
Park, ER;Wolfe, TJ;Rigotti, NA
目的：评估成人初级保健专科住院医师对预防保健和心理社会问题咨询患者的感知准备。设计：横断面全国居民邮件调查（63%回复率）。参与者：来自162个美国学术健康中心的928名内科（IM）、家庭执业（FP）和妇产科（OB/GYN）的最后一年初级保健住院医师。测量：住院医师自评是否准备好向病人咨询吸烟、饮食和运动、药物滥用、家庭暴力和抑郁症。结果：居民对吸烟（62%）、饮食和运动（53%）的咨询比抑郁症（37%）、药物滥用（36%）或家庭暴力（21%）的咨询准备得更好。在大多数地区，女性比男性准备得更充分。在调整性别、种族、医学院位置和门诊培训的百分比后，不同专业的咨询准备率差异显著。计划生育住院医师比妇产科住院医师对吸烟、饮食、运动和抑郁症的咨询准备得更好，而妇产科住院医师比IM或计划生育住院医师对家庭暴力的咨询准备得更好。住院医师对准备程度的认知介于其他两个专科之间。在门诊环境中花费的培训比例与居民的感知准备无关。结论：完成成人初级保健住院医师在向患者提供预防和心理社会问题咨询方面没有做好充分准备。即使在调整了在门诊环境中花费的时间差异后，各专业之间也存在显著差异。增加住院医师在门诊的时间可能并不足以确保住院医师具备足够的咨询技能。
OBJECTIVE: To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues.DESIGN: Cross-sectional national mail survey of residents (63% response rate).PARTICIPANTS: Nine hundred twenty-eight final-year primary care residents in Internal Medicine (IM), family practice (FP), and Obstetrics/Gynecology (OB/GYN) at 162 U.S. academic health centers.MEASUREMENTS: Residents self-rated preparedness to counsel patients about smoking, diet and exercise, substance abuse, domestic violence, and depression.RESULTS: Residents felt better prepared to counsel about smoking (62%) and diet and exercise (53%) than about depression (37%), substance abuse (36%), or domestic violence (21%). In most areas, females felt better prepared than males. Rates of counseling preparedness varied significantly by specialty after adjustment for gender, race, medical school location, and percent of training spent in ambulatory settings. FP residents felt better prepared than OB/GYN residents to counsel about smoking, diet and exercise, and depression, while OB/GYN residents felt better prepared to address domestic violence than IM or FP residents. IM residents' perceptions of preparedness were between the other 2 specialties. Proportion of training spent in ambulatory settings was not associated with residents' perceived preparedness.CONCLUSIONS: Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills.