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首页> 外文期刊>The Journal of Graduate Medical Education >How Residents Say They Learn: A National, Multi-Specialty Survey of First- and Second-Year Residents
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How Residents Say They Learn: A National, Multi-Specialty Survey of First- and Second-Year Residents

机译：居民如何说他们学习：第一和第二年居民的国家，多种专业调查

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Introduction Formal instruction is only 1 part of the resident's total education. Alongside this formal curriculum are a host of parallel learning experiences that have become known as the informal or hidden curriculum, within which are embedded the values and norms of the profession.1–3 These values are communicated in a number of subtle and not so subtle ways by peers and faculty.4,5 Little is known about these less structured aspects of education for residents. This report seeks to provide unique data on how residents say they learn, gleaned from a large, random, multi-specialty survey of first- and second-year residents, conducted in 1999, prior to the 2003 Accreditation Council for Graduate Medical Education (ACGME) work hour limits.6 As such, it provides historical information on how residents assess their own learning modes, as well as a baseline for examining possible changes under the 2003 work hour standards. National multi-specialty surveys conducted by the American Medical Association (AMA) in 1983 and 1987 found that instruction to residents averaged 6.8 hours per week, ranging from 7.3 hours per week for first-year residents to 5.2 hours after their fourth year of training.7 International medical graduates (IMGs) reported receiving significantly more instructional time than did US medical graduates (USMGs). Among all residents, higher satisfaction with training has usually been associated with more formal instruction, such as frequent contact with attending physicians, lectures, and grand rounds.7,8 Phy and associates reported resident satisfaction was positively associated with increased faculty presence in the afternoon or evening.9 However, faculty and residents' perceptions sometimes differ about what constitutes effective learning activities.10–12 Stress, fatigue, sleep deprivation, and “burnout” have been found to impair learning and performance,13,14 and only about half of residents attend didactic teaching conferences, with fewer still reporting they remain alert throughout.15,16 Our own previous 1989 national, multi-specialty survey found that, although quantity and quality of time with attending physicians was most valued by residents, they also ranked “other residents” and “special patients” as additional important sources of learning.8 Positive factors contributing to satisfaction with their internship year were, in order, attending physicians, other residents, patient rounds, seminars, and time with attending physicians.;Discussion Differences in the 3 sources of learning were associated both positively and negatively with a number of empirical variables relevant to the residents' perception of their educational experience, including overall satisfaction with residency, conflicts with medical staff, reports of medical errors, and average weekly duty hours. We also documented the importance of resident peers as a key source of learning, especially during the first year of residency. Finally, we found that residents' ratings of their learning experience could be predicted by a model that incorporates the 3 learning factors, along with ratings of their time with attending physicians. Faculty-organized learning showed the most robust correlations with a range of associated variables. As the importance of this factor increased, reports of negative behaviors such as significant medical errors, conflicts with medical staff, alcohol use, and unethical conduct decreased. Residents appear to regard faculty involvement as the key issue fostering both learning and a positive residency experience. This finding confirms our previous work demonstrating that contact with attending physicians was a strong predictor of satisfaction during residency.8 The identification of resident peers as an important source of learning suggests that the education of residents requires not just formal, faculty-organized activities, but also a forum in which trainees learn from and teach each other. The combination of faculty-organize
机译：简介正式指导只是居民的总教育的一部分。除此之外，这种正式课程是一系列并行学习体验，已被称为非正式或隐藏的课程，其中嵌入了行业的价值观和规范.1-3这些值在许多微妙中传达，而不是如此微妙地传达通过同行和教师的方式对于居民的教育方面的这些较少的结构方面而言。本报告旨在提供有关居民如何学习的独特数据，从1999年在2003年毕业生医学教育（ACGME）（ACGME）之前在1999年进行的一九九九年和二年级居民的大型，随机，多专业调查中获集）工作时间限制如此，它提供有关居民如何评估自己的学习模式的历史信息，以及在2003年工作时间标准下检查可能变化的基准。 1983年和1987年美国医学协会（AMA）进行的国家多种专业调查发现，居民的指示每周平均为6.8小时，从一年的培训年级居民每周7.3小时到5.2小时。 7国际医学毕业生（IMG）报告收到比美国医学毕业生（USMGS）的教学时间更大。在所有居民中，与培训的更高满意度通常与更正式的指导相关，例如与主治医生，讲座和大轮频繁联系.7,8 Phy和Associates报告的居民满意是与下午增加的教师存在相关的居民满意度或者晚上.9然而，教师和居民的看法有时对什么构成有效的学习活动.10-12压力，疲劳，睡眠剥夺和“倦怠”被发现损害学习和表现，13,14只有大约一半居民参加教学教学会议，仍然报告仍然报告仍然是警惕，他们在整个1989年全国1989年的国家，多种专业调查发现，虽然上任医生的数量和时间数量被居民最有价值，但它们也排名“其他居民”和“特殊患者”作为额外的学习来源.8促成满足的阳性因素为了他们的实习年度，符合他们的实习年度，参加医生，其他居民，患者，研讨会和参加医生的时间。; 3学习来源的讨论差异与许多有关的经验变量有关和负面相关居民对其教育经验的看法，包括与居留权的总体满意度，与医务人员的冲突，医疗错误的报告和平均每周税率。我们还记录了居民同行作为一个主要学习来源的重要性，特别是在居住的第一年。最后，我们发现居民的学习经验评级可以通过融合3个学习因素的模型来预测，以及他们与参加医生的时间的评级。教师组织的学习显示了与一系列相关变量的最强大的相关性。随着该因素的重要性增加，对诸如重大医疗错误，与医务人员，酒精使用和不道德行为相冲突的报告减少。居民似乎认为教师参与作为促进学习和积极居住经验的关键问题。这一发现证实了我们以前的工作，表明与上任医生的联系是在居住期间的满意度的强烈预测因素.8作为一个重要的学习来源的常驻同伴的识别表明，居民的教育不仅需要正式，教师组织的活动，但是此外，学员互相教育的论坛也是一个论坛。教师组织的结合

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