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Perspectives on medical education. 2025 May 8;14(1):264-273. doi: 10.5334/pme.1627

Learning from Reflection on Patient Outcomes Data: How EHR Can Support Trainees in Graduate Medical Education on Inpatient Rotations

从患者结果数据的反思中学习:电子健康记录如何支持住院医师轮转中的医学教育工作者学员 翻译改进

Margaret A Robinson  1, Christy Boscardin  2, Marieke Van der Schaaf  3, Justin L Sewell  4, Glenn Rosenbluth  5

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作者单位

  • 1 Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
  • 2 Departments of Medicine, and Department of Anesthesia, University of California San Francisco, San Francisco, California, USA.
  • 3 Research and Development of Health Professions Education, University Medical Center Utrecht, The Netherlands.
  • 4 Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
  • 5 Department of Pediatrics, University of California San Francisco in San Francisco, California, USA.
  • DOI: 10.5334/pme.1627 PMID: 40351521

    摘要 中英对照阅读

    Introduction: As healthcare evolves into interdisciplinary, complex, team-based care that often includes shiftwork and sub-specialization, patient outcomes data has become necessary for trainees to engage in reflective practice in clinical environments. However, current practices around collecting and distributing such data to trainees are not effective. Specifically, it is not clear what patient data are significant and compelling to trainees for reflective practice. The goal of our study was to characterize trainee perspectives on what data are meaningful to promote reflective activities for learning in the clinical work environment.

    Methods: From 2020-2021, we conducted a longitudinal cross-sectional study to assess trainee interest in clinical outcomes data. Over 14 days, pediatrics and internal medicine residents doing inpatient work at the University of California San Francisco completed surveys corresponding to recently opened patient charts.

    Results: 958 surveys were completed by 41 participants (average 23 unique patient encounters per participant). Trainees expressed interest in follow-up for 32.9% of encounters (n = 315/958), most often to 'learn if something significant or unexpected happened.' Trainees most often desired follow-up patient data when they had made significant decisions or felt responsible.

    Discussion: Trainees were interested in clinical outcomes data for a limited number of patient encounters, highlighting challenges with current strategies to promote reflective practice using clinical outcomes data. While refinement of such approaches continues through consideration of what trainees find meaningful in data, understanding motivating and demotivating factors in trainees' outcomes data-seeking behaviors will also be crucial for success in using such data for learning opportunities.

    Keywords:electronic health records; patient outcomes; graduate medical education

    介绍: 随着医疗保健发展成为跨学科、复杂的团队协作模式,常常包括轮班工作和亚专业分工,患者结果数据已成为培训生在临床环境中进行反思性实践所必需的。然而,目前收集和向培训生分发此类数据的做法并不有效。具体来说,不清楚哪些患者数据对培训生具有重要意义并能促进他们的反思性实践活动。我们研究的目标是描述培训生对于何种数据有意义、能够促进临床工作环境中的学习活动的看法。

    方法: 从2020年至2021年,我们进行了一项纵向横断面研究,以评估培训生对临床结果数据的兴趣。在为期14天的时间内,加州大学旧金山分校的儿科和内科住院医生完成了与最近打开的患者病历相对应的调查问卷。

    结果: 共有41名参与者(平均每位23个独特的患者病例)完成了958份问卷。对于32.9%的案例,培训生表达了进行后续跟进的兴趣(共完成315/958次)。他们最常表达的是想要了解“是否发生了重要的或出乎意料的事情”。在他们做出重要决定或感到责任重大时,培训生最希望获得患者数据。

    讨论: 对于有限数量的患者案例,培训生对临床结果数据表现出兴趣,这突显了目前通过使用临床结果数据促进反思性实践策略所面临的挑战。虽然继续通过考虑培训生在数据中发现的价值所在来完善这种方法,但理解促使和阻碍培训生寻求结果数据行为的因素也将是成功利用此类数据进行学习机会的关键。

    关键词:电子健康记录; 患者预后; 毕业后医学教育

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