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Scope of Practice Among Recent Family Medicine Residency Graduates

机译：近期家庭医学住院医师毕业生的业务范围

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The scope of practice among primary care providers varies, and studies have shown that family physicians’ scope may be shrinking. We studied the scope of practice among graduates of residencies associated with Preparing the Personal Physician for Practice (P4) and how length of training and individualized education innovations may influence scope. Methods: We surveyed graduates 18 months after residency between 2008 and 2014. The survey measured self-reported practice characteristics, scope of practice and career satisfaction. We assessed scope using individual practice components (25 clinical activities, 30 procedures) and a scaled score (P4-SOP) that measured breadth of practice scope. We conducted subgroup analyses according to exposure to innovations over the project period and exposure to specific innovations. Results: No significant differences were found in mean P4-SOP scores between the Pre and Full P4 groups. Compared to national data, P4 graduates reported higher rates for vaginal deliveries (19.3% vs 9.2%), adult inpatient care (48.5% vs 33.7%) and nursing home care (25.4 vs 11.7%) in practice. Graduates exposed to innovations that lengthened training, compared to standard training length, were more likely to include adult hospital care (58.2% vs 38.5%, P=0.002), adult ICU care (30.6% vs 19.2%, P=0.047) and newborn resuscitation (25.6% vs 14%, P=0.028) in their practice and performed 19/30 procedures at higher rates. Graduates of programs with individualized training innovations reported no significant differences in scope compared to graduates without this innovation. Conclusions: Graduates of residencies engaged in significant educational redesign report a broad scope of practice. Innovations around the length of training may broaden scope and individualized education appears not to constrict scope.
机译：初级保健提供者的执业范围各不相同，研究表明，家庭医生的范围可能正在缩小。我们研究了与准备执业医师（P4）相关的住院医师应届毕业生的执业范围，以及培训时间和个性化教育创新如何影响范围。方法：我们对2008年至2014年居住后18个月的毕业生进行了调查。该调查测量了自我报告的执业特征，执业范围和职业满意度。我们使用个人执业组成部分（25个临床活动，30个程序）和可衡量执业范围广度的量表评分（P4-SOP）评估范围。我们根据项目期间的创新风险和特定创新的风险进行了分组分析。结果：Pre和Full P4组之间的平均P4-SOP得分没有显着差异。与全国数据相比，P4毕业生在实践中报告的阴道分娩率更高（19.3％比9.2％），成人住院治疗（48.5％比33.7％）和养老院护理（25.4比11.7％）更高。与标准培训时间相比，接受延长培训的创新的毕业生更可能包括成人医院护理（58.2％vs 38.5％，P = 0.002），成人ICU护理（30.6％vs 19.2％，P = 0.047）和新生儿复苏（25.6％vs 14％，P = 0.028），并以较高的比率进行了19/30程序。与没有此项创新的毕业生相比，具有个性化培训创新的计划的毕业生报告的范围没有显着差异。结论：从事重大教育重新设计的驻地毕业生报告了广泛的实践范围。围绕培训时间的创新可能会扩大范围，而个性化的教育似乎不会限制范围。

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