Abstract
BackgroundThe 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.MethodsCross-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.ResultsOf 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.ConclusionThe 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.
Highlights
The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training
The skills and knowledge of physicians improve through a combination of didactic and experiential learning that can in turn contribute to improving patient care [1]
The overall model consisted of one quality-of-care outcome variable, portrayed by the vignettes, and four predictor variables, that is, selfestimates of total number of patients seen, type of institution, and self-reports of clinical competence and communication ability
Summary
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. Attention to quality of patient care has become an important healthcare issue during the last decade, for health authorities, policymakers, and managers, and for physicians and patients. Physicians are one of the main healthcare providers and are confronted with increasing pressure to provide and improve care. The skills and knowledge of physicians improve through a combination of didactic and experiential learning that can in turn contribute to improving patient care [1]. The number of clinical cases seen might be an important factor linked to quality of care
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