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Transitions of Care in Medical Education: A Compilation of Effective Teaching Methods

机译：医学教育中护理的过渡：有效教学方法的汇编

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Background and Objectives: Transitioning patients safely from the inpatient environment back to an outpatient environment is an important component of health care, and multidisciplinary cooperation and formal processes are necessary to accomplish this task. This Transitions of Care (TOC) process is constantly being shaped in health care systems to improve patient safety, outcomes, and satisfaction. While there are many models that have been published on methods to improve the TOC process systematically, there is no clear roadmap for educators to teach TOC concepts to providers in training. This article reviews published data to highlight specific methods shown to effectively instill these concepts and values into medical students and residents. Formal, evidence-based, TOC curriculum should be developed within medical schools and residency programs. TOC education should ideally begin early in the education process, and its importance should be reiterated throughout the curriculum longitudinally. Curriculum should have a specific focus on recognition of common causes of hospital readmissions, such as medication errors, lack of adequate follow-up visits, and social/economic barriers. Use of didactic lectures, case-based workshops, role-playing activities, home visits, interprofessional activities, and resident-led quality improvement projects have all be shown to be effective ways to teach TOC concepts.(Fam Med 2016;48(4):265-72.)The medical community recognizes the importance of a smooth transition from the inpatient to outpatient setting and the role it plays in determining patient outcomes, readmission rates, and overall hospital costs.1 Many evidence-based interventions have been published that improve patient safety and outcomes during the transitions process (Table 1).2-7 However, these transition programs were not specifically designed to enhance knowledge of transitions of care (TOC) for providers in training. Further, these programs are generally broadscale and require extensive resources within large health care systems, which may not be feasible within smaller teaching institutions. A 2009 multidisciplinary TOC policy statement nicely outlines ideal practices regarding TOC, but it does not highlight how these practices should best be taught to providers in training.8 It is apparent there is a disconnect between the expectations that the medical community has regarding the vital role of TOC and the emphasis TOC receives in medical training. We have identified and compiled the published successful, evidence-based strategies focused on teaching TOC with the hopes that this compilation will serve as a resource for educational programs dedicated to improving provider in training education about TOC.Table1
机译：背景与目的：安全地将患者从住院环境转移到门诊环境是医疗服务的重要组成部分，完成此任务需要多学科合作和正式程序。在医疗保健系统中，这种护理过渡（TOC）流程正在不断成形，以提高患者的安全性，治疗效果和满意度。尽管已经发布了许多关于系统地改进TOC流程的方法的模型，但对于教育者在培训中向提供者传授TOC概念没有明确的路线图。本文回顾了已发表的数据，重点介绍了可以有效地将这些概念和价值观灌输给医学生和住院医师的特定方法。正规的，循证的TOC课程应该在医学院和住院医师课程中开发。理想情况下，TOC教育应在教育过程中尽早开始，并且应在整个课程中纵向重申其重要性。课程应特别着重于识别医院再次入院的常见原因，例如用药错误，缺乏足够的随访以及社会/经济障碍。使用教学法讲座，基于案例的讲习班，角色扮演活动，家访，跨职业活动以及以居民为主导的质量改善项目都被证明是教授TOC概念的有效方法。（Fam Med 2016; 48（4） ：265-72。）医学界意识到从住院到门诊平稳过渡的重要性及其在确定患者预后，再入院率和整体医院费用中所起的作用。1许多基于证据的干预措施已经发表，在过渡过程中提高患者的安全性和结果（表1）。2-7但是，这些过渡计划并不是专门为增强培训提供者的护理过渡（TOC）知识而设计的。此外，这些计划通常是大规模的，需要大型卫生保健系统中的大量资源，而在较小的教学机构中可能不可行。 2009年的多学科TOC政策声明很好地概述了有关TOC的理想做法，但并未强调应如何最好地将这些做法教给医务人员培训。8显然，医学界对关键作用的期望之间存在脱节。 TOC和TOC在医学培训中得到的重视。我们已经确定并汇编了已发表的成功的，循证的，专注于教学TOC的策略，希望这一汇编将成为致力于改善TOC培训教育提供者的教育计划的资源。

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