内部医学住院诊所的初级保健例外规则:益处,缺点,最佳实践和改革建议
Benjamin D Gallagher1, Pamela D Vohra-Khullar2, Stephen Fuest3
1Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. benjamin.gallagher@yale.edu.
Journal of general internal medicine
|December 3, 2024
概括
初级保健例外规则 (PCER) 允许在门诊诊所间接监督居民. 这一观点考察了PCER.
科学领域:
- 医学教育 医学教育
- 内部医疗住院内科医生
- 主要护理实践的初级护理实践
背景情况:
- 门诊连续性诊所对于内科住院培训至关重要.
- 初级保健例外规则 (PCER) 允许对低复杂度访问进行间接监督,但其影响未得到充分研究.
- 关于PCER对患者,住院人员和主治医生的影响的文献有限.
研究的目的:
- 分析PCER对所有利益相关者的好处和缺点.
- 建议在居民培训中实施PCER的最佳实践.
- 建议进行改革,以优化PCER的效用和扩大其应用.
主要方法:
- 这一观点是由一个由主要内科学会和利益集团代表组成的工作组制定的.
- 它涉及到对当前PCER利用及其影响的批判性审查.
- 讨论重点是利益相关者的观点和基于证据的建议.
主要成果:
- PCER提供了潜在的好处,但也带来了风险,特别是当患者病史或体检至关重要时.
- 目前的做法往往依赖于基于时间的监督,这可能无法确保能力.
- 利益相关者包括患者,居民,主治医生和卫生系统,每个都有独特的考虑因素.
结论:
- 应谨慎使用PCER,避免关键的诊断/管理遭遇.
- 建议过渡到基于能力的监督基准.
- 将PCER扩展到中等复杂度的访问,能力评估后的评估和进一步的研究对于改革至关重要.
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