The effect of patient care order sets on medical resident education: a prospective before-after study

BMC Medical Education

Samir Gupta¹  Anne L Stephenson¹  Catherine H Yu¹ 

[1] Department of Medicine, University of Toronto, Toronto, Canada

关键词: Clinical competence;    Patient admission;    Hospital information systems;    Guideline adherence;    Medical education;    Internship and residency;    Medical order entry systems;    Clinical decision support systems;   

Others  :  1138589
DOI  :  10.1186/1472-6920-13-146

 received in 2013-09-10, accepted in 2013-10-30,  发布年份 2013

【 摘 要 】

Background

Patient care order sets are increasingly being used to optimize care. While studies have evaluated the impact of order sets on provider performance and patient outcomes, their impact on postgraduate medical trainee knowledge remains unknown. We sought to evaluate the impact of order sets on respirology knowledge, order-writing skills, and self-reported learning.

Methods

We conducted a prospective before-after study. Postgraduate trainees completing a Respirology rotation at a quaternary-care hospital 6 months before (no order set period) and 12 months after (order set period) order set introduction. Guideline-based admission order sets with educational prompts detailing recommended management of cystic fibrosis and chronic obstructive pulmonary disease were implemented on the respirology ward. Each resident completed a test before and after the rotation assessing knowledge and order-writing. Residents in the order set period additionally completed a questionnaire regarding the impact of order set use on their learning. Analysis: The primary outcome, the difference between pre and post rotation scores was compared between residents in the no order set period and residents in the order set period, using univariate linear regression. Test validity was assessed with a 2-sample t-test, analysis of variance and Pearson’s correlation coefficient. Self-reported impact of order set use were descriptively analyzed, and written responses were collated and coded.

Results

Investigators consecutively recruited 11 subjects before and 28 subjects after order set implementation. Residents in the order set period had a greater improvement in post-rotation test scores than residents in the no order set period (p = 0.04); after adjustment for baseline scores, this was not significant (p = 0.3). The questionnaire demonstrated excellent convergent, discriminant and construct validity. Residents reported that order sets improved their knowledge and skills and provided a systematic approach to care.

Conclusions

Order sets do not appear to impair resident education, and may impart a benefit. This will require validation in larger studies and across diseases.

【 授权许可】

   
2013 Yu et al.; licensee BioMed Central Ltd.

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