在初级保健中学习驾驭不确定性:范围界定文献综述。

IF 2.5 Q2 PRIMARY HEALTH CARE BJGP Open Pub Date : 2024-07-29 Print Date: 2024-07-01 DOI:10.3399/BJGPO.2023.0191
Nick P Gardner, Gerard J Gormley, Grainne P Kearney
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引用次数: 0

摘要

背景:临床实践是在不确定的情况下进行的。初级医疗是一个接受和处理不确定性的临床环境,与二级医疗不同。最近的文献综述有助于了解临床不确定性如何在教育环境中传授,如何在二级医疗机构中驾驭,以及在较小程度上由经验丰富的全科医生驾驭。我们还不知道医学生和接受培训的医生是如何在初级医疗中学习驾驭不确定性的:目的:在这篇范围综述中,我们提出了这样一个问题:人们对全科医疗作为学习驾驭不确定性的机会了解多少?对英文文章进行范围界定综述:采用范围界定综述方法,检索了 Embase、Medline 和 Web of Science 数据库,并通过引文检索获得了其他文章。如果研究(a)基于医学生和/或受训医生群体,且(b)考虑了初级医疗或模拟初级医疗环境中的临床不确定性或模糊性,则纳入本综述。对研究结果进行了专题分析:结果:共纳入了 36 项研究,并从中提出了三大主题:不确定性有助于专业身份的形成(PIF)、适应性反应和不适应行为。确定了影响 PIF 的关系和社会因素。适应性反应包括调整认识期望和共同决策:教育者可以发挥关键作用,通过社会化、讨论初级保健认识论、识别不适应行为和培养建设性应对不确定性的文化,帮助学习者驾驭不确定性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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Learning to navigate uncertainty in primary care: a scoping literature review.

Background: Clinical practice occurs in the context of uncertainty. Primary care is a clinical environment that accepts and works with uncertainty differently from secondary care. Recent literature reviews have contributed to understanding how clinical uncertainty is taught in educational settings and navigated in secondary care, and, to a lesser extent, by experienced GPs. We do not know how medical students and doctors in training learn to navigate uncertainty in primary care.

Aim: To explore what is known about primary care as an opportunity for learning to navigate uncertainty.

Design & setting: Scoping review of articles written in English.

Method: Using a scoping review methodology, Embase, MEDLINE, and Web of Science databases were searched, with additional articles obtained through citation searching. Studies were included in this review if they: (a) were based within populations of medical students and/or doctors in training; and (b) considered clinical uncertainty or ambiguity in primary care or a simulated primary care setting. Study findings were analysed thematically.

Results: Thirty-six studies were included from which the following three major themes were developed: uncertainty contributes to professional identity formation (PIF); adaptive responses; and maladaptive behaviours. Relational and social factors that influence PIF were identified. Adaptive responses included adjusting epistemic expectations and shared decision making (SDM).

Conclusion: Educators can play a key role in helping learners navigate uncertainty through socialisation, discussing primary care epistemology, recognising maladaptive behaviours, and fostering a culture of constructive responses to uncertainty.

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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
期刊最新文献
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