了解手术主治经验和观点的可变性,关于知情同意及其如何影响住院医师教育设计:一项新的调查以电子方式分发,以探索教师外科医生的个人学习经验,知识,临床实践,关于知情同意的教学偏好和信念。进行卡方和Kruskal-Wallis测试以寻找关联,并进行聚类分析以阐明其中的其他模式。
单身,第三级,大学附属医疗保健系统(康涅狄格州的耶鲁纽黑文健康),包括6家教学医院。
外科系内的临床教师。
共有85名外科医生做出反应(反应率为49%),代表17个专业,私人执业和大学和/或医院聘用,经过多年的实践。在所有年龄段,专业,学习(86%)和教学(82%)最常用的知情同意方法是观察主治医师.那些声称通过观察出席者学习的受访者更有可能报告他们通过让受训者观察他们来教学(OR8.5,95%CI1.3-56.5),而通过出席者观察他们来回忆学习的参与者更有可能观察他们的受训者(OR4.1,95%CI1.5-11.2)。聚类分析显示5种不同的主治表型,组间差异显著。一群年轻的参与者报告说,他们的学习经验最不多样化,对法律责任和居民能力的关注程度很高。他们很少采用教授居民的策略。相比之下,报告最多样化学习经历的集群也向居民报告了最多样化的教学策略,但很少允许居民与患者进行同意。同时,2其他集群提供了更平衡的经验与一些机会的实践与患者和一些多样性的教学-这些集群,分别,由年长的人组成,在创伤和/或重症监护方面经验丰富的普通外科医生和外科医生。
外科医生的人口统计,个人经历,和专业似乎对他们的教学风格和居民在知情同意方面获得的教育经验产生了重大影响。
To understand the variability of surgical attending experience and perspectives regarding informed consent and how it impacts resident education DESIGN: A novel survey was distributed electronically to explore faculty surgeon\'s personal learning experience, knowledge, clinical practice, teaching preferences and beliefs regarding informed consent. Chi-square and Kruskal-Wallis testing was performed to look for associations and a cluster analysis was performed to elucidate additional patterns among.
Single, tertiary, university-affiliated health care system (Yale New Haven Health in Connecticut), including 6 teaching hospitals.
Clinical faculty within the Department of Surgery.
A total of 85 surgeons responded (49% response rate), representing 17 specialties, both private practice and university and/or hospital-employed, with a range of years in practice. Across all ages, specialties, the most common method for both learning (86%) and teaching (82%) informed consent was observation of the attending. Respondents who stated they learned by observing attendings were more likely to report that they teach by having trainees observe them (OR 8.5, 95% CI 1.3-56.5) and participants who recalled learning by having attendings observe them were more likely to observe their trainees (OR 4.1, 95% CI 1.5-11.2).Cluster analysis revealed 5 different attending phenotypes with significant heterogeneity between groups. A cluster of younger attendings reported the least diverse learning experience and high levels of concern for legal liability and resident competency. They engaged in few strategies for teaching residents. By comparison, the cluster that reported the most diverse learning experience also reported the richest diversity of teaching strategies to residents but rarely allowed residents to perform consent with their patients. Meanwhile, 2 other cluster provided a more balanced experience with some opportunities for practice with patients and some diversity of teaching- these clusters, respectively, consist of older, experienced general surgeons and surgeons in trauma and/or critical care.
Surgeon\'s demographics, personal experiences, and specialty appear to significantly influence their teaching styles and the educational experience residents receive regarding informed consent.