Transitioning into the ICU team - The experience of International Medical Graduates (IMGs) during a North American Fellowship Training Program in Critical Care

转入 ICU 团队 - 国际医学毕业生 (IMG) 在北美重症监护奖学金培训项目中的经验

• 批准号: 396644946
• 负责人: Dr. Anne Mecklenburg
• 金额: --
• 依托单位: Sunnybrook Research Institute (SRI)
• 依托单位国家: 德国
• 项目类别: Research Fellowships
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2017-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/396644946?language=en
• 关键词: Transitioning; into; ICU; team; experience

IMGs represent an integral part of many health care systems around the world, e.g. 25% of practicing physicians in Canada and 8% in Germany are IMGs. When they pursue clinical training in a different country, IMGs face the need to adapt to an unfamiliar medical system and environment, and to learn the culture, organization and processes of the new hospital and unit. The practice of critical care is complex, time-sensitive and highly dependent on inter-disciplinary teamwork. In fact, effective team work has been tied to better patient outcomes in ICU. To function as trainees in such an environment, IMGs must quickly learn how to interact within an ICU team, and how to coordinate their own clinical activities with those of other physicians and allied health professionals. Understanding the "rules of the game" may represent a unique challenge for IMGs starting their critical care fellowship. The inability or delayed ability to adapt to their new training environment may be problematic for the trainees and for patient care. In addition, the unique role of a critical care fellow within the North-American postgraduate medical system is an unfamiliar and novel experience for many IMGs who trained in countries without fellowship programs. IMGs may not fully grasp the dual, sometimes conflictual nature (supervisor-supervisee; leader-follower) of the fellow's role. A better understanding of the process of transition for IMG-fellows into their ICU team is important for optimal patient care and training.This study aims to better understand how IMGs integrate within their intra- and interdisciplinary ICU teams during the first year of their Critical Care fellowship with the University of Toronto. More specifically, this project will explore: 1.) IMG fellows' perceptions of their roles and responsibilities within intra- and inter-professional ICU teams; 2.) challenges encountered by IMG fellows as they transition into their new professional role as ICU team member; 3.) strategies used by IMG fellows to overcome these challenges. Our results will inform the development of strategies and initiatives to support IMG fellows and ICU team members during this transition period. Ultimately, a better and/or faster integration of IMG fellows within the ICU team will lead to more effective teamwork, improved team performance, and better patient care.

IMG代表着世界各地许多医疗保健系统不可或缺的一部分，例如，加拿大25%的执业医生和德国8%的执业医生是IMG。当IMG在不同的国家进行临床培训时，他们面临着适应陌生的医疗系统和环境，以及学习新医院和单位的文化、组织和流程的需要。重症监护的实践是复杂的、对时间敏感的，并且高度依赖跨学科的团队合作。事实上，有效的团队合作与ICU中更好的患者结局息息相关。为了在这样的环境中作为实习生发挥作用，IMG必须迅速学会如何在ICU团队中互动，以及如何协调自己的临床活动与其他医生和专职卫生专业人员的活动。理解“游戏规则”可能代表着IMG开始他们的重症监护联谊会的一个独特的挑战。不能或延迟适应新的训练环境的能力可能会给受训人员和病人护理带来问题。此外，对于许多在没有奖学金计划的国家接受培训的IMG来说，危重护理研究员在北美研究生医疗体系中的独特角色是一种陌生和新鲜的经历。IMG可能没有完全理解研究员角色的双重性质，有时甚至是冲突性质(主管-被监督者；领导者-追随者)。更好地了解IMG成员过渡到ICU团队的过程对于优化患者护理和培训非常重要。本研究旨在更好地了解IMG如何在他们与多伦多大学重症监护团契的第一年内融入他们的学科内和跨学科ICU团队。更具体地说，这个项目将探索：1)IMG研究员对他们在ICU内部和跨专业团队中的角色和责任的认知；IMG研究员在过渡到其作为ICU小组成员的新的专业角色时遇到的挑战；IMG研究员为克服这些挑战而采取的战略。我们的结果将有助于制定战略和倡议，在过渡期间支持IMG研究员和ICU团队成员。最终，更好和/或更快地将IMG研究员整合到ICU团队中将导致更有效的团队合作、更好的团队绩效和更好的患者护理。

项目成果

Critical Care Canada Forum 2018 Abstracts

• DOI: 10.1007/s12630-019-01292-0
• 发表时间: 2019-01
• 期刊: Canadian Journal of Anaesthesia
• 作者: T. Millen;B. Gomes;F. Auld;V. Williams;J. Marchand;I. Georgescu;Eileen F. Campbell;T. Bentall;T. Campbell;Patricia Lizotte;L. Lavoie;M. Dionne;L. Saunders;J. Johnstone;Cook;Deborah

39th International Symposium on Intensive Care and Emergency Medicine

第39届国际重症监护和急诊医学研讨会

• DOI: 10.1186/s13054-019-2358-0
• 发表时间: 2019
• 期刊: Critical Care
• 影响因子: 15.1
• 作者: A Mecklenburg;U Najeeb;L Rose;L Lingard;D Piquette
• 通讯作者: D Piquette