背景:当代的一般实践包括多种远程遭遇。电话的兴起,分诊和临床护理的视频和在线模式需要对临床医生和支持人员进行培训,无论是个人还是团队,但是基于证据的能力以前还没有被用于一般实践。
目标:为了确定培训需求,核心能力,以及提供远程接触的员工的学习方法。
方法:英国一般实践中的混合方法研究。
方法:数据来自12种一般做法的纵向人种学案例研究;多利益相关者研讨会;与政策制定者的访谈,培训提供者,和学员;发表的研究;和灰色文献(如培训材料和调查)。数据进行了主题编码,并使用个人和团队学习理论进行了分析。
结果:学习提供远程服务发生在高工作负载的情况下,人员不足,和复杂的工作流。低信心和未满足的培训需求很常见。临床医生新手的培训重点包括基本的技术技能,分诊,道德(隐私和同意),以及沟通和临床技能。既定的临床医生培训重点包括高级沟通技能(例如,保持融洽和专注),在技术范围内工作,做出复杂的判断,在分布式环境中协调多专业护理,和训练其他人。现有的许多培训都是教学和技术重点。虽然通常使用这种方法获得基本知识,做出复杂判断的能力和信心通常是通过经验获得的,非正式讨论,以及阴影等在职方法。整个团队的培训很有价值,但很少可用。根据调查结果提供了一套能力草案。
结论:为不同的患者群体提供高质量的远程接触所需的知识是复杂的,集体,和组织嵌入。非说教训练的重要作用,例如,联合临床会议,基于案例的讨论,当面,整个团队,在职培训,需要被承认。
BACKGROUND: Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice.
OBJECTIVE: To identify training needs, core competencies, and learning methods for staff providing remote encounters.
METHODS: Mixed-methods study in UK general practice.
METHODS: Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning.
RESULTS: Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians\' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings.
CONCLUSIONS: The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.