有能力的医生的角色是专业人士,根据加拿大医学教育专家指令(CanMEDS)框架,这描述了医生需要有效地满足他们所服务的人的医疗保健需求的能力。通过检查主持人对居民表现的现场笔记,作者确定了家庭医学居民与之抗争的这一角色的各个方面。
作者在这项定性研究中使用了结构化的主题分析,以探索多伦多大学家庭和社区医学系研究生医学学习者收到的书面反馈。分析了临床教育工作者在2015年至2017年之间为在CanMEDS专业角色中得分“低于预期”的居民撰写的70份现场笔记。从自由文本评论中,作者推导了归纳法,把代码合并成主题,并测量了代码出现的频率。然后,作者将主题映射到CanMEDS专业角色的关键能力。
从字段注释中,出现了7个主题,描述了表现不佳的原因。缺乏合议,未能遵守实践标准或法律准则,缺乏反思或自我学习被确定为主要问题。其他主题是未能保持界限,采取可能对患者护理产生负面影响的行动,未能保持患者的机密性,以及无法自我照顾。当主题映射到CanMEDS专业角色的关键能力时,最重要的是“对职业的承诺”。“
这项研究强调了居民与之抗争的专业行为方面,并建议应该重新评估在住院医师计划以及所有医疗培训级别中教授专业精神的方式。强调学习者对专业的承诺的教育干预措施可以促进更多专业人员的发展。
Among the roles of the competent physician is that of a professional, according to the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which describes the abilities physicians require to effectively meet the health care needs of the people they serve. Through examination of preceptor field notes on resident performance, the authors identified aspects of this role with which family medicine residents struggle.
The authors used a structured thematic analysis in this qualitative study to explore the written feedback postgraduate medical learners receive at the University of Toronto Department of Family and Community Medicine. Seventy field notes written between 2015 and 2017 by clinical educators for residents who scored \"below expectation\" in the CanMEDS professional role were analyzed. From free-text comments, the authors derived inductive codes, amalgamated the codes into themes, and measured the frequency of the occurrence of the codes. The authors then mapped the themes to the key competencies of the CanMEDS professional role.
From the field notes, 7 themes emerged that described reasons for poor performance. Lack of collegiality, failure to adhere to standards of practice or legal guidelines, and lack of reflection or self-learning were identified as major issues. Other themes were failure to maintain boundaries, taking actions that could have a negative impact on patient care, failure to maintain patient confidentiality, and failure to engage in self-care. When the themes were mapped to the key competencies in the CanMEDS professional role, most related to the competency \"commitment to the profession.\"
This study highlights aspects of professional conduct with which residents struggle and suggests that the way professionalism is taught in residency programs-and at all medical training levels-should be reassessed. Educational interventions that emphasize learners\' commitment to the profession could enhance the development of more practitioners who are consummate professionals.