背景:患者越来越多地使用基于网络的评估工具来评估他们的医生,医疗队,和整体医疗经验。
目的:本研究旨在评估CanMEDS框架的标准化医师能力在基于网络的患者评价(WPR)中的存在程度,并确定患者对癌症优质护理背景下重要医师素质的看法。
方法:收集了加拿大安大略省医学院中等城市所有大学附属医学肿瘤学家的WPR。两名审稿人(1名传播研究研究员和1名医疗保健专业人员)根据CanMEDS框架独立评估WPR并确定共同主题。然后评估评论得分,以确定审稿人之间的κ同意率,并完成了队列的描述性定量分析。在定量分析之后,进行了归纳主题分析.
结果:这项研究确定了安大略省中等城市地区的49名积极执业的大学附属医学肿瘤学家。总共确定了473份审查这49名医生的WPR。在CanMEDS能力中,那些定义医学专家角色的人,传播者,专业人士最普遍(303/473,64%;182/473,38%;129/473,27%,分别)。WPR的共同主题包括医疗技能和知识,人际交往能力,回答问题(从病人到医生)。详细的WPR往往包括以下要素:经验和联系;对医师知识的讨论和评估,敬业精神,人际交往能力,和守时;在正面评价中,表达感激之情和推荐;在负面评论中,不鼓励寻求医生的护理。患者对医疗技能的感知不如他们对人际关系品质的感知具体,尽管医疗技能是WPR中最受关注的护理要素。患者对人际交往能力的感知(倾听,同情,和整体关怀的举止)和其他体验现象,例如在约会时感到匆忙,通常是具体和详细的。关于医生的人际交往能力或“床边方式”的细节被高度感知,估值,并且可在WPR上下文中共享。少数WPR反映了医疗技能的价值与人际交往技能的价值之间的区别。这些WPR的作者声称,对他们来说,医生的医疗技能和能力比他们的人际交往能力更重要。
结论:明确面向患者的CanMEDS角色和能力(即,患者在与医生的互动中以及通过医生提供的护理直接经历的那些)最有可能出现并在WPR中报告。研究结果表明,有机会向WPR学习,不仅仅是辨别医生的受欢迎程度,而是要掌握患者对医生的期望。在这种情况下,WPR可以表示用于测量和评估面向患者的医师能力的方法。
BACKGROUND: Patients increasingly use web-based evaluation tools to assess their physicians, health care teams, and overall medical experience.
OBJECTIVE: This study aimed to evaluate the extent to which the standardized physician competencies of the
CanMEDS Framework are present in web-based patient reviews (WPRs) and to identify patients\' perception of important physician qualities in the context of quality cancer care.
METHODS: The WPRs of all university-affiliated medical oncologists in midsized cities with medical schools in the province of Ontario (Canada) were collected. Two reviewers (1 communication studies researcher and 1 health care professional) independently assessed the WPRs according to the
CanMEDS Framework and identified common themes. Comment scores were then evaluated to identify κ agreement rates between the reviewers, and a descriptive quantitative analysis of the cohort was completed. Following the quantitative analysis, an inductive thematic analysis was performed.
RESULTS: This study identified 49 actively practicing university-affiliated medical oncologists in midsized urban areas in Ontario. A total of 473 WPRs reviewing these 49 physicians were identified. Among the
CanMEDS competencies, those defining the roles of medical experts, communicators, and professionals were the most prevalent (303/473, 64%; 182/473, 38%; and 129/473, 27%, respectively). Common themes in WPRs include medical skill and knowledge, interpersonal skills, and answering questions (from the patient to the physician). Detailed WPRs tend to include the following elements: experience and connection; discussion and evaluation of the physician\'s knowledge, professionalism, interpersonal skills, and punctuality; in positive reviews, the expression of feelings of gratitude and a recommendation; and in negative reviews, discouragement from seeking the physician\'s care. Patients\' perception of medical skills is less specific than their perception of interpersonal qualities, although medical skills are the most commented-on element of care in WPRs. Patients\' perception of interpersonal skills (listening, compassion, and overall caring demeanor) and other experiential phenomena, such as feeling rushed during appointments, is often specific and detailed. Details about a physician\'s interpersonal skills or \"bedside manner\" are highly perceived, valued, and shareable in an WPR context. A small number of WPRs reflected a distinction between the value of medical skills and that of interpersonal skills. The authors of these WPRs claimed that for them, a physician\'s medical skills and competence are more important than their interpersonal skills.
CONCLUSIONS: CanMEDS roles and competencies that are explicitly patient facing (ie, those directly experienced by patients in their interactions with physicians and through the care that physicians provide) are the most likely to be present and reported on in WPRs. The findings demonstrate the opportunity to learn from WPRs, not simply to discern physicians\' popularity but to grasp what patients may expect from their physicians. In this context, WPRs can represent a method for the measurement and assessment of patient-facing physician competency.