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自主,委托,自我效能和决策:培训独立外科医生的现状
Christine Kariya1, Mina Boutrous1, Kwame S Amankwah1
1Department of Surgery, Division of Vascular and Endovascular Surgery, University of Connecticut School of Medicine, Farmington, CT.
Seminars in vascular surgery
|June 16, 2025
概括
外科住院医生的操作自主性正在下降,但研究表明,培训员的独立性增加不会损害患者的结果. 培养信任和能力可以改善外科培训,创造熟练的外科医生.
科学领域:
- 医学教育 医学教育
- 进行外科手术培训.
- 患者安全 患者安全
背景情况:
- 操作自主性,委托,自我效能和决策对于外科住院医生教育至关重要.
- 近几十年来,在外科子专业中,实习生的操作自主性下降了.
- 追溯研究表明,培训人员独立性增加并没有显著影响患者的发病率或死亡率.
研究的目的:
- 探索影响外科住院生操作自主性的因素.
- 识别给实习生提供更多独立性的障碍.
- 提出提高学员自主性和自我效能的策略.
主要方法:
- 对临床结果的回顾性研究的审查,与不同程度的学员独立性.
- 在授权自主权时,主持外科医生考虑的因素分析 (实习生技能,病例复杂性,主持信心,与实习生的关系).
- 识别障碍,如效率要求和患者/医院对临床手术的期望等.
主要成果:
- 没有观察到患者发病率和死亡率的显著增加,而学员的操作独立性更大.
- 自主性的障碍包括效率目标和对外科医生进行手术的外部期望.
- 实习生可以通过建立关系,展示能力和适应教学风格来提高自我效能和自主性.
结论:
- 增强外科住院医生的自主性对于培养有能力,自给自足的外科医生至关重要.
- 诸如纵向评估和角色逆转等策略可以提高自主性.
- 需要患者,管理人员和立法者认识到在培训中运营独立的重要性.
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