预期或回避:内科住院医师进行侵入性床边手术的经验

Canadian medical education journal Pub Date : 2023-11-08 eCollection Date: 2023-11-01 DOI:10.36834/cmej.73122
Alyssa S Louis, Christie Lee, Andrea V Page, Shiphra Ginsburg
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引用次数: 0

摘要

背景:内科(IM)住院医师需要执行诊断和治疗目的的床边程序。由于不清楚的原因,住院医生对手术的体验差别很大。目的:探讨住院医师在床边操作方面的经验,并找出获得足够经验的障碍和促进因素。方法:采用归纳主题方法,我们在2017-2018学年在加拿大三级医疗中心对7名IM居民(共12名居民)进行了5次个人半结构化访谈和1次焦点小组访谈。我们使用反复的、开放式的问题来引出住院医生的经验、障碍和促进因素,以执行床边程序。使用Braun和Clarke的方法分析主题的转录本。结果:我们确定了四个主题:1)患者特定因素,如身体习惯和手术紧迫性;2)系统因素,如时间限制和材料的可及性;3)教师因素,包括监督的可用性、舒适度和转诊偏好;4)住院医师特定因素,包括准备、先前经验和信心。一些住院医生表现出与手术相关的焦虑和回避。结论:旨在提高手术效率和确保督导人员可用性的教育干预可能有助于促进住院医师执行手术,但可能无法解决手术相关焦虑。需要进一步的研究来更好地理解厌恶手术的居民如何获得信心来寻求手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anticipation or avoidance: internal medicine resident experiences performing invasive bedside procedures.

Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents' experiences with procedures vary widely, for unclear reasons.

Objective: To explore IM residents' experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience.

Methods: Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents' experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke's method.

Results: We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials; 3) Faculty factors including availability to supervise, comfort level, and referral preferences, and 4) Resident-specific factors including preparation, prior experiences, and confidence. Some residents expressed procedure-related anxiety and avoidance.

Conclusion: Educational interventions aimed to improve procedural efficiency and ensure availability of supervisors may help facilitate residents to perform procedures, yet may not address procedure-related anxiety. Further study is required to understand better how procedure-averse residents can gain confidence to seek out procedures.

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