Medical student shadowing on hospital medicine direct-care services

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Daniel J. Aldrich MD, Shannon K. Martin MD, MS
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Coinciding with HM's growth as a field, HM direct-care services (HM-DCS), or services in which a hospitalist is the sole primary provider, are increasingly utilized in medical education.<span><sup>3</sup></span> The clinical practice of HM, however, is demanding, and some may fear incorporating early learners on HM-DCS may cause greater provider stress, distracting multitasking, and lower productivity.<span><sup>4-6</sup></span></p><p>More than ever before, hospitalist educators must navigate tensions between clinical demands and the educational mission.<span><sup>7, 8</sup></span> A key strategy offered by HM leaders is developing innovative educational opportunities beyond traditional teaching services.<span><sup>9</sup></span> A well-designed shadowing program can meet this need, and hospitalist educators can excel in creating such programs with a thoughtful approach to design, implementation, and evaluation. Applying Kern's approach to curriculum development and central strategies of implementation science,<span><sup>10, 11</sup></span> we present a model of preclerkship (i.e., first and second-year medical student) shadowing on HM-DCS at the Pritzker School of Medicine (PSOM) at the University of Chicago Medicine (UCM) that demonstrates how HM-DCS can be successful learning environments for shadowing students while facilitating satisfying teaching opportunities for hospitalists.</p><p>Before 2021, PSOM students lacked formal opportunities to shadow in HM. To meet this need, the Section of HM at UCM partnered with PSOM to create an HM-DCS shadowing intervention, or Hospital Medicine Shadowing Experience (HMSE), available to first- and second-year PSOM students and UCM hospitalists.</p><p>UCM, a tertiary academic medical center, has 13 general medicine and subspecialty HM-DCS comprising medically and psychosocially complex patients. HM-DCS cap at 11–14 patients and are staffed by approximately 70 hospitalists with varying teaching responsibility levels. Seven-day HM-DCS rotations begin Monday, Wednesday, or Thursday. PSOM, whose campus is adjacent to UCM, has roughly two preclerkship years followed by clinical rotations. Classes are approximately 88 students.</p><p>We chose DCS for shadowing students because, unlike traditional teaching services with interns, residents, and other students, they enable a 1:1 apprentice-teacher model, which may allow a more direct interface with patient care and the health system and enhance physician role-modeling and mentorship while not overcrowding traditional teaching services with additional learners.</p><p>We first identified stakeholders and considered facilitators and barriers to implementation in our context. Based on these, we decided participation would be voluntary, students and hospitalists would be paired 1:1, and shadowing would last a minimum of 2 h and occur on Sundays. We considered that restricting shadowing to Sundays could decrease exposure to the scope of HM practice but accepted this tradeoff in favor of reasons such as accommodating student class schedules. To establish program objectives, we conducted a prepilot needs assessment from February to March 2021. General advertisements were disseminated via email. Students and hospitalists were paired based on availability. The only prepilot guideline was shadowing should last at least 2 h. Within 2 weeks of participation, students and hospitalists were asked to provide narrative feedback.</p><p>We reassessed facilitators and barriers following feedback review and established the following formal HMSE objectives: (1) educate students about HM careers; (2) provide students clinical education; (3) enhance students' professional identity formation (PIF)—that is, the process through which students come to think, act, and feel like physicians—through preceptor role modeling and experiential learning<span><sup>12</sup></span>; (4) provide hospitalists satisfying teaching opportunities; and (5) minimize clinical disruption. Table 1 outlines key implementation strategies. The full pilot was subsequently formulated.</p><p>HMSE was piloted from April 2021 to June 2023. Several HMSE components were modified or introduced based on the needs assessment. For example, we implemented a hospitalist tip sheet highlighting strategies to streamline workflow, teach and engage students, discuss HM careers, and be a physician role model (Table 2). Tailored advertisements were disseminated each fall and spring. HMSE components were iteratively refined following the annual survey analysis.</p><p>One week following participation, student and first-time hospitalist participants received survey invitations (Appendix A). Participants were surveyed over 3 academic years (AYs) from 2020 to 2023. Fifty-two students shadowed 19 unique hospitalists over 55 instances. Student participation increased after the first AY and was stable thereafter; hospitalist participation was similar across AYs (Appendix B). Student and hospitalist survey response rates were 95% (52/55) and 84% (16/19), respectively.</p><p>Students shadowed for a mean 3.3 h (SD 1.0) on a mean 10.1 patients (SD 3.1). Most (79%) reported direct-clinical engagement (e.g., taking histories). Twenty-one percent of students observed consultation with a specialist, and 75% discussed nonclinical HM career opportunities (e.g., quality improvement). Students and hospitalists were highly satisfied with HMSE. Among students, 98% were satisfied overall with HMSE; 98% were satisfied with hospitalist role modeling; 98% with clinical teaching; and 85% with direct-clinical engagement. Among hospitalists, 88% were satisfied overall with HMSE with 94% satisfied with the opportunity to teach (Appendix C). Satisfaction was stable across AYs (Appendix D). All students reported an increased understanding of HM clinical practice, 95% reported an increased understanding of nonclinical HM opportunities, and over half (56%) reported increased interest in pursuing an HM career.</p><p>We were additionally interested in measuring the impact of HMSE on HM-DCS clinical workflow. Nearly all hospitalists (94%) perceived workflow disruption. It was not feasible to assess certain disruption endpoints, like delays and omissions in placing orders and consults. Thus, to assess whether shadowing resulted in delays in hospitalist work completion, we examined the following electronic health record data: (1) mean time of progress note and discharge summary entry; (2) mean percentage of notes copied from prior notes; (3) mean number of discharge orders placed; and (4) and mean time of discharge order entry. Data were collected for patients on the hospitalist preceptors' census on shadowing Sundays and the immediately preceding non-shadowing Saturdays, which had similar mean total notes and mean new admissions. The mean time of note entry was 44 min later on shadowing versus nonshadowing days (<i>p</i> &lt; .001). Mean time of discharge order entry was 51 min later on shadowing days, but this difference was not significant (<i>p</i> = .15); differences for other measures of workflow disruption also were not significant (Appendix E).</p><p>We describe a successful model for preclerkship medical student shadowing on HM-DCS. HMSE educated students about HM careers. Further, HMSE was a feasible and sustainable teaching opportunity for hospitalist educators. Here, we highlight several important findings for HM groups implementing shadowing experiences for early learners on HM-DCS.</p><p>In medical education, PIF derives from a complex network of social interactions, experiential learning, and explicit and tacit knowledge acquisition.<span><sup>12</sup></span> Consequently, role modeling exerts an important influence on medical student career choices and shapes students' PIF through clinical teaching.<span><sup>13, 14</sup></span> Our survey data, including high student-reported interest in HM following HMSE, supports success in achieving our objectives of educating students about HM, providing clinical education and engagement, and promoting physician role modeling, which was consistently rated very highly. While favorable for students in the short term, we believe the impact of HMSE could also influence student PIF, whether students decide to become hospitalists or not. For example, the extremely positive experience students reported having with hospitalist role models in HMSE could improve perceptions about HM and even strengthen interprofessional collaboration between future physicians in HM and non-HM specialties. HMSE does not aim to turn every student into a hospitalist, but rather to highlight the unique role and expertise hospitalists bring as leaders of inpatient teams, a feature supported by the high number of students reporting better understanding of both clinical and nonclinical elements of HM.</p><p>We predicted clinical disruption would be our greatest implementation barrier. Unsurprisingly, nearly all hospitalist respondents perceived workflow disruption. While all objective measures of workflow disruption trended in the direction supporting this perception, only the difference in mean note entry time reached statistical significance. It is plausible, however, that the nonsignificant differences for our other workflow measures reflect type II error given our sample size. Despite the challenge of workflow disruption, we maintained stable hospitalist participation and high satisfaction throughout the pilot which supports success in achieving our last objective of mitigating disruption. This is especially important given the current climate of diminished teaching opportunities throughout the HM landscape and the need to develop additional venues for clinical teaching.<span><sup>7, 8</sup></span> Future work describing measures of hospitalist workflow should incorporate contributions hospitalists perceive from educational responsibilities, such as those in HMSE.<span><sup>15</sup></span></p><p>We also recognize student survey feedback has the potential to aid faculty promotion. Although our results were not linked to official learner evaluations, we recommend that other groups employing shadowing models consider the value of program evaluation for this purpose, particularly for faculty with high clinical responsibilities and fewer opportunities to receive learner evaluations.</p><p>DCS are valuable clinical learning environments, even for early learners. We believe HMSE has the potential for future dissemination not only for HM groups at other institutions but also on DCS in non-HM specialties.<span><sup>16</sup></span> For groups considering the HMSE model in their own context, we advise special attention to implementation science principles—especially in settings with higher patient loads which could adversely impact implementation—and recommend a methodical approach that includes conducting a thorough stakeholder analysis to identify facilitators and barriers, developing theory-based strategies to leverage facilitators and mitigate barriers, systematically measuring outcomes aligned with objectives, and iteratively modifying HMSE in response to evolving results.</p><p>A structured shadowing intervention on HM-DCS can educate students about HM and may contribute to career exploration and PIF. 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引用次数: 0

Abstract

Physician shadowing, or observation of the day-to-day work of a physician, is a time-honored way to introduce students to medical careers and patient care but can be challenging to implement.1, 2 Hospital medicine (HM) requires broad expertise in clinical and health systems sciences and provides an opportune environment for valuable and diverse clinical shadowing experiences. Coinciding with HM's growth as a field, HM direct-care services (HM-DCS), or services in which a hospitalist is the sole primary provider, are increasingly utilized in medical education.3 The clinical practice of HM, however, is demanding, and some may fear incorporating early learners on HM-DCS may cause greater provider stress, distracting multitasking, and lower productivity.4-6

More than ever before, hospitalist educators must navigate tensions between clinical demands and the educational mission.7, 8 A key strategy offered by HM leaders is developing innovative educational opportunities beyond traditional teaching services.9 A well-designed shadowing program can meet this need, and hospitalist educators can excel in creating such programs with a thoughtful approach to design, implementation, and evaluation. Applying Kern's approach to curriculum development and central strategies of implementation science,10, 11 we present a model of preclerkship (i.e., first and second-year medical student) shadowing on HM-DCS at the Pritzker School of Medicine (PSOM) at the University of Chicago Medicine (UCM) that demonstrates how HM-DCS can be successful learning environments for shadowing students while facilitating satisfying teaching opportunities for hospitalists.

Before 2021, PSOM students lacked formal opportunities to shadow in HM. To meet this need, the Section of HM at UCM partnered with PSOM to create an HM-DCS shadowing intervention, or Hospital Medicine Shadowing Experience (HMSE), available to first- and second-year PSOM students and UCM hospitalists.

UCM, a tertiary academic medical center, has 13 general medicine and subspecialty HM-DCS comprising medically and psychosocially complex patients. HM-DCS cap at 11–14 patients and are staffed by approximately 70 hospitalists with varying teaching responsibility levels. Seven-day HM-DCS rotations begin Monday, Wednesday, or Thursday. PSOM, whose campus is adjacent to UCM, has roughly two preclerkship years followed by clinical rotations. Classes are approximately 88 students.

We chose DCS for shadowing students because, unlike traditional teaching services with interns, residents, and other students, they enable a 1:1 apprentice-teacher model, which may allow a more direct interface with patient care and the health system and enhance physician role-modeling and mentorship while not overcrowding traditional teaching services with additional learners.

We first identified stakeholders and considered facilitators and barriers to implementation in our context. Based on these, we decided participation would be voluntary, students and hospitalists would be paired 1:1, and shadowing would last a minimum of 2 h and occur on Sundays. We considered that restricting shadowing to Sundays could decrease exposure to the scope of HM practice but accepted this tradeoff in favor of reasons such as accommodating student class schedules. To establish program objectives, we conducted a prepilot needs assessment from February to March 2021. General advertisements were disseminated via email. Students and hospitalists were paired based on availability. The only prepilot guideline was shadowing should last at least 2 h. Within 2 weeks of participation, students and hospitalists were asked to provide narrative feedback.

We reassessed facilitators and barriers following feedback review and established the following formal HMSE objectives: (1) educate students about HM careers; (2) provide students clinical education; (3) enhance students' professional identity formation (PIF)—that is, the process through which students come to think, act, and feel like physicians—through preceptor role modeling and experiential learning12; (4) provide hospitalists satisfying teaching opportunities; and (5) minimize clinical disruption. Table 1 outlines key implementation strategies. The full pilot was subsequently formulated.

HMSE was piloted from April 2021 to June 2023. Several HMSE components were modified or introduced based on the needs assessment. For example, we implemented a hospitalist tip sheet highlighting strategies to streamline workflow, teach and engage students, discuss HM careers, and be a physician role model (Table 2). Tailored advertisements were disseminated each fall and spring. HMSE components were iteratively refined following the annual survey analysis.

One week following participation, student and first-time hospitalist participants received survey invitations (Appendix A). Participants were surveyed over 3 academic years (AYs) from 2020 to 2023. Fifty-two students shadowed 19 unique hospitalists over 55 instances. Student participation increased after the first AY and was stable thereafter; hospitalist participation was similar across AYs (Appendix B). Student and hospitalist survey response rates were 95% (52/55) and 84% (16/19), respectively.

Students shadowed for a mean 3.3 h (SD 1.0) on a mean 10.1 patients (SD 3.1). Most (79%) reported direct-clinical engagement (e.g., taking histories). Twenty-one percent of students observed consultation with a specialist, and 75% discussed nonclinical HM career opportunities (e.g., quality improvement). Students and hospitalists were highly satisfied with HMSE. Among students, 98% were satisfied overall with HMSE; 98% were satisfied with hospitalist role modeling; 98% with clinical teaching; and 85% with direct-clinical engagement. Among hospitalists, 88% were satisfied overall with HMSE with 94% satisfied with the opportunity to teach (Appendix C). Satisfaction was stable across AYs (Appendix D). All students reported an increased understanding of HM clinical practice, 95% reported an increased understanding of nonclinical HM opportunities, and over half (56%) reported increased interest in pursuing an HM career.

We were additionally interested in measuring the impact of HMSE on HM-DCS clinical workflow. Nearly all hospitalists (94%) perceived workflow disruption. It was not feasible to assess certain disruption endpoints, like delays and omissions in placing orders and consults. Thus, to assess whether shadowing resulted in delays in hospitalist work completion, we examined the following electronic health record data: (1) mean time of progress note and discharge summary entry; (2) mean percentage of notes copied from prior notes; (3) mean number of discharge orders placed; and (4) and mean time of discharge order entry. Data were collected for patients on the hospitalist preceptors' census on shadowing Sundays and the immediately preceding non-shadowing Saturdays, which had similar mean total notes and mean new admissions. The mean time of note entry was 44 min later on shadowing versus nonshadowing days (p < .001). Mean time of discharge order entry was 51 min later on shadowing days, but this difference was not significant (p = .15); differences for other measures of workflow disruption also were not significant (Appendix E).

We describe a successful model for preclerkship medical student shadowing on HM-DCS. HMSE educated students about HM careers. Further, HMSE was a feasible and sustainable teaching opportunity for hospitalist educators. Here, we highlight several important findings for HM groups implementing shadowing experiences for early learners on HM-DCS.

In medical education, PIF derives from a complex network of social interactions, experiential learning, and explicit and tacit knowledge acquisition.12 Consequently, role modeling exerts an important influence on medical student career choices and shapes students' PIF through clinical teaching.13, 14 Our survey data, including high student-reported interest in HM following HMSE, supports success in achieving our objectives of educating students about HM, providing clinical education and engagement, and promoting physician role modeling, which was consistently rated very highly. While favorable for students in the short term, we believe the impact of HMSE could also influence student PIF, whether students decide to become hospitalists or not. For example, the extremely positive experience students reported having with hospitalist role models in HMSE could improve perceptions about HM and even strengthen interprofessional collaboration between future physicians in HM and non-HM specialties. HMSE does not aim to turn every student into a hospitalist, but rather to highlight the unique role and expertise hospitalists bring as leaders of inpatient teams, a feature supported by the high number of students reporting better understanding of both clinical and nonclinical elements of HM.

We predicted clinical disruption would be our greatest implementation barrier. Unsurprisingly, nearly all hospitalist respondents perceived workflow disruption. While all objective measures of workflow disruption trended in the direction supporting this perception, only the difference in mean note entry time reached statistical significance. It is plausible, however, that the nonsignificant differences for our other workflow measures reflect type II error given our sample size. Despite the challenge of workflow disruption, we maintained stable hospitalist participation and high satisfaction throughout the pilot which supports success in achieving our last objective of mitigating disruption. This is especially important given the current climate of diminished teaching opportunities throughout the HM landscape and the need to develop additional venues for clinical teaching.7, 8 Future work describing measures of hospitalist workflow should incorporate contributions hospitalists perceive from educational responsibilities, such as those in HMSE.15

We also recognize student survey feedback has the potential to aid faculty promotion. Although our results were not linked to official learner evaluations, we recommend that other groups employing shadowing models consider the value of program evaluation for this purpose, particularly for faculty with high clinical responsibilities and fewer opportunities to receive learner evaluations.

DCS are valuable clinical learning environments, even for early learners. We believe HMSE has the potential for future dissemination not only for HM groups at other institutions but also on DCS in non-HM specialties.16 For groups considering the HMSE model in their own context, we advise special attention to implementation science principles—especially in settings with higher patient loads which could adversely impact implementation—and recommend a methodical approach that includes conducting a thorough stakeholder analysis to identify facilitators and barriers, developing theory-based strategies to leverage facilitators and mitigate barriers, systematically measuring outcomes aligned with objectives, and iteratively modifying HMSE in response to evolving results.

A structured shadowing intervention on HM-DCS can educate students about HM and may contribute to career exploration and PIF. Utilizing DCS for shadowing experiences may also enhance career satisfaction for hospitalist educators.

The authors declare no conflict of interest.

This program was granted exemption by the University of Chicago Institutional Review Board (IRB21-0629).

Abstract Image

医科学生跟班学习医院医疗直接护理服务。
医生见习,或观察医生的日常工作,是一种向学生介绍医疗事业和病人护理的历史悠久的方式,但实施起来可能具有挑战性。1,2医院医学(HM)需要临床和卫生系统科学方面的广泛专业知识,并为有价值和多样化的临床实习经验提供了一个合适的环境。随着HM作为一个领域的发展,HM直接护理服务(HM- dcs),或由医院医生作为唯一主要提供者的服务,越来越多地用于医学教育然而,HM的临床实践要求很高,有些人可能担心将早期学习者纳入HM- dcs可能会导致更大的提供者压力,分散多任务处理和降低生产力。比以往任何时候,医院教育工作者都必须处理好临床需求和教育使命之间的紧张关系。HM领导人提出的一项关键战略是在传统教学服务之外开发创新的教育机会一个设计良好的见习项目可以满足这一需求,而医院教育工作者可以在设计、实施和评估方面采用深思熟虑的方法来创建这样的项目。将Kern的方法应用于课程开发和实施科学的核心策略10,11,我们提出了一个在芝加哥大学医学院(UCM)普利兹克医学院(PSOM)对HM-DCS进行实习的见习模型(即一年级和二年级医学生),该模型展示了HM-DCS如何在为医院医生提供满意的教学机会的同时,成功地为见习学生提供学习环境。在2021年之前,PSOM的学生缺乏在HM实习的正式机会。为了满足这一需求,UCM的HM部门与PSOM合作创建了HM- dcs影子干预,或医院医学影子经验(HMSE),适用于PSOM的一年级和二年级学生和UCM的医院医生。UCM是一个三级学术医疗中心,拥有13个全科和亚专科的HM-DCS,包括医学和心理社会复杂的患者。HM-DCS有11-14名病人,由大约70名不同教学责任级别的医院医生组成。7天的HM-DCS轮换从周一、周三或周四开始。PSOM的校园毗邻UCM,大约有两年的实习时间,然后是临床轮转。班级大约有88名学生。我们选择DCS来指导学生,因为与传统的实习生、住院医生和其他学生的教学服务不同,DCS实现了1:1的学徒-教师模式,这可能允许与患者护理和卫生系统更直接的接口,增强医生的角色塑造和指导,同时不会使传统的教学服务因额外的学习者而过度拥挤。我们首先确定了利益相关者,并考虑了在我们的背景下实施的促进因素和障碍。基于这些,我们决定参与将是自愿的,学生和医院医生将一对一配对,影子将持续至少2小时,并在周日进行。我们认为,将影子限制在周日可能会减少HM实践的范围,但为了适应学生的课程安排等原因,我们接受了这种权衡。为了确定项目目标,我们于2021年2月至3月进行了预试点需求评估。一般的广告是通过电子邮件传播的。学生和医院医生根据可用性进行配对。唯一的预驾驶指导方针是跟随应该持续至少2小时。在参与的两周内,要求学生和医院医生提供叙述反馈。根据反馈意见,我们重新评估了促进因素和障碍,并建立了以下正式的HMSE目标:(1)教育学生关于HM职业;(2)对学生进行临床教育;(3)通过导师角色塑造和体验式学习,增强学生的职业认同形成(PIF),即学生像医生一样思考、行动和感受的过程;(4)为医院医师提供满意的教学机会;(5)尽量减少临床干扰。表1概述了关键的实现策略。随后制订了完整的试点方案。HMSE从2021年4月到2023年6月进行了试点。根据需求评估,修改或引入了几个HMSE组件。例如,我们实施了一份医院医生提示单,突出了简化工作流程、教授和吸引学生、讨论HM职业以及成为医生榜样的策略(表2)。定制广告在每年秋季和春季传播。根据年度调查分析,对HMSE成分进行迭代改进。参与一周后,学生和首次成为医院医生的参与者收到了调查邀请(附录A)。参与者在2020年至2023年的3个学年(ay)内接受了调查。 52名学生在55个案例中跟踪了19名不同的医院医生。学生的参与度在第一次AY后有所增加,此后保持稳定;住院医生的参与情况在不同的ae中相似(附录B)。学生和住院医生的调查回复率分别为95%(52/55)和84%(16/19)。学生对平均10.1名患者(SD 3.1)进行平均3.3小时(SD 1.0)的跟踪。大多数(79%)报告了直接临床参与(例如,记录病史)。21%的学生观察了与专家的咨询,75%的学生讨论了非临床的HM职业机会(例如,质量改进)。学生和医院人员对医院医疗服务的满意度较高。在学生中,98%的人对HMSE总体满意;98%的受访患者对医院医生的角色塑造满意;98%为临床教学;85%是直接临床参与。在医院医生中,88%的人对HMSE总体感到满意,94%的人对教学机会感到满意(附录C)。所有学生的满意度都很稳定(附录D)。所有学生都表示对HM临床实践的了解有所增加,95%的人表示对非临床HM机会的了解有所增加,超过一半(56%)的人表示对追求HM职业的兴趣增加。我们还对测量HMSE对HM-DCS临床工作流程的影响感兴趣。几乎所有的医院医生(94%)都认为工作流程中断。评估某些中断端点是不可行的,例如下订单和咨询的延迟和遗漏。因此,为了评估阴影是否会导致医院医生工作完成的延迟,我们检查了以下电子健康记录数据:(1)进度记录和出院摘要条目的平均时间;(2)从先前笔记中复制的笔记的平均百分比;(三)平均出院单数量;(4)和平均放行单录入时间。数据收集了住院医师导师在周日和之前的周六进行的人口普查,这两个周六的平均总记录和平均新入院人数相似。与非阴影日相比,阴影日记录笔记的平均时间延迟了44分钟(p &lt; .001)。随访日患者平均出院单输入时间延迟51 min,但差异无统计学意义(p = 0.15);其他测量工作流程中断的差异也不显著(附录E)。我们描述了一个成功的模型,用于实习前医学学生在HM-DCS上的跟踪。HMSE对学生进行了HM职业教育。此外,HMSE是一个可行和可持续的教学机会,为医院教育工作者。在这里,我们强调了HM小组在HM- dcs上为早期学习者实施影子体验的几个重要发现。在医学教育中,PIF来源于社会互动、体验式学习以及显性和隐性知识获取的复杂网络因此,角色塑造对医学生的职业选择有重要影响,并通过临床教学塑造医学生的PIF。13,14我们的调查数据,包括高学生报告的HMSE后对HM的兴趣,支持成功实现我们的目标,教育学生HM,提供临床教育和参与,并促进医生的角色建模,这一直被评为非常高。虽然在短期内对学生有利,但我们认为HMSE的影响也会影响学生的PIF,无论学生是否决定成为医院医生。例如,学生们报告说,他们对医院医生榜样的非常积极的体验可以改善他们对医院医生的看法,甚至可以加强未来医院医生和非医院医生专业之间的跨专业合作。HMSE的目标不是让每个学生都成为医院医生,而是强调医院医生作为住院团队领导者的独特作用和专业知识,这一特点得到了大量学生的支持,他们报告说,他们对HM的临床和非临床因素都有了更好的理解。我们预测临床干扰将是我们实施的最大障碍。不出所料,几乎所有受访的医院医生都认为工作流程受到了干扰。虽然所有工作流程中断的客观测量都倾向于支持这种看法的方向,但只有平均笔记输入时间的差异具有统计学意义。这是合理的,然而,我们的其他工作流程测量的不显著差异反映了我们的样本量的类型II误差。尽管面临工作流程中断的挑战,但我们在整个试点过程中保持了稳定的医院医生参与和高满意度,这有助于成功实现我们减轻中断的最后目标。鉴于目前整个HM领域的教学机会减少以及需要开发额外的临床教学场所,这一点尤为重要。 7,8未来描述医院医生工作流程的工作应纳入医院医生从教育责任中获得的贡献,如在hmse中的贡献。15我们也认识到学生调查的反馈有可能有助于教师的晋升。虽然我们的研究结果与官方的学习者评估没有联系,但我们建议其他采用影子模型的团体考虑项目评估的价值,特别是对于那些临床责任高、接受学习者评估机会少的教师。DCS是有价值的临床学习环境,即使对早期学习者也是如此。我们相信,HMSE不仅在其他机构的HM群体中具有传播潜力,而且在非HM专业的DCS中也具有传播潜力对于在自己的环境中考虑HMSE模型的团体,我们建议特别注意实施科学原则-特别是在患者负荷较高的环境中,这可能会对实施产生不利影响-并建议一种有条不紊的方法,包括进行彻底的利益相关者分析,以确定促进因素和障碍,制定基于理论的策略,以利用促进因素和减轻障碍,系统地衡量与目标一致的结果。并根据不断变化的结果迭代修改HMSE。对HM- dcs进行结构化的影子干预可以教育学生HM,并可能有助于职业探索和PIF。利用DCS进行见习也可以提高医院教育工作者的职业满意度。作者声明无利益冲突。该项目获得了芝加哥大学机构审查委员会(IRB21-0629)的豁免。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of hospital medicine
Journal of hospital medicine 医学-医学:内科
CiteScore
4.40
自引率
11.50%
发文量
233
审稿时长
4-8 weeks
期刊介绍: JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.
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