Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine
| Autor: | Yoshinori Noguchi, Kunihiko Matsui, Yasuaki Hayashino, John W. Peabody, Yoshihiko Hirao, Taro Minami, Hiroyasu Ishimaru, Dan Bertenthal, Kazuhiko Kikawa, Umihiko Sawada, Ino T, Yohei Fukumoto, Jin Seino, Junichiro Hayano, Yoshitomo Mutoh, S. Fukuhara, Norio Higuma |
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| Rok vydání: | 2006 |
| Předmět: |
Multivariate statistics
medicine.medical_specialty Self-Evaluation Programs Time Factors Cross-sectional study lcsh:Medicine Workload Education Outcome variable Japan Internal medicine Internal Medicine Humans Medicine Quality of care Hospitals Teaching Quality of Health Care Medicine(all) lcsh:LC8-6691 Medical education lcsh:Special aspects of education business.industry lcsh:R Univariate Internship and Residency General Medicine Cross-Sectional Studies Family medicine Workforce Clinical Competence Clinical competence business Institutional Practice Research Article Graduation |
| Zdroj: | BMC Medical Education, Vol 6, Iss 1, p 33 (2006) BMC Medical Education |
| ISSN: | 1472-6920 |
| DOI: | 10.1186/1472-6920-6-33 |
| Popis: | Background The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training. We aimed to determine the association between clinical exposure (number of cases seen), self- reports of clinical competence, and type of institution (predictor variables) and quality of care (outcome variable) as measured by clinical vignettes. Methods Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan. Participants were physicians-in-training in internal medicine departments. Main outcome measure was standardized t-scores (quality of care) derived from responses to five clinical vignettes. Results Of the 375 eligible participants, 263 (70.1%) completed the vignettes. Most were in their first (57.8%) and second year (28.5%) of training; on average, the participants were 1.8 years (range = 1–8) after graduation. Two thirds of the participants (68.8%) worked in university-affiliated teaching hospitals. The median number of cases seen was 210 (range = 10–11400). Greater exposure to cases (p = 0.0005), higher self-reports of clinical competence (p = 0.0095), and type of institution (p < 0.0001) were significantly associated with higher quality of care, using a multivariate linear model and adjusting for the remaining factors. Quality of care rapidly increased for the first 100 to 200 cases seen and tapered thereafter. Conclusion The amount of clinical exposure and levels of self-reports of clinical competence, not years after graduation, were positively associated with quality of care, adjusting for the remaining factors. The learning curve tapered after about 200 cases. |
| Databáze: | OpenAIRE |
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