Hibbert M L, Salminen E R, Dainty L A, Davis G D, Perez R P
Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington 98431, USA.
Obstet Gynecol. 2000 Dec;96(6):1014-7. doi: 10.1016/s0029-7844(00)01062-0.
To determine whether incorporation of routine intraoperative cystoscopy for evaluation of potential urinary tract injury into gynecologic residency training provides sufficient experience to justify hospital credentials after graduation.
We developed a curriculum to train residents in intraoperative cystoscopic evaluation of potential lower urinary tract injury. Cystoscopy was performed when indicated with hysterectomy and routinely in conjunction with pelvic reconstruction. Faculty members evaluated conceptual and technical proficiency by oral examination and direct observation in the operating room. Once the resident demonstrated a thorough understanding and proficiency in performing intraoperative cystoscopy, a competency certification document was issued by the Program Director. This certification was transmitted to the postresidency hospital credentials committee to justify granting privileges.
Since 1994 over 400 transurethral cystoscopic evaluations have been done in conjunction with major gynecologic abdominal and vaginal surgeries, and since 1997 an additional 50 transvesical microcystoscopies have been done in selected abdominal cases. Twenty-five residency graduates have been certified as fully trained in intraoperative diagnostic cystoscopy. All these graduates have been granted intraoperative cystoscopy privileges at their subsequent hospital practice.
Incorporation of cystoscopic urinary tract evaluation into routine gynecologic surgical training is good medical practice and provided a mechanism whereby obstetrics and gynecology residents could obtain intraoperative cystoscopy hospital privileges after graduation. (Obstet Gynecol 2000;96:1014-7.)
确定将评估潜在尿路损伤的术中膀胱镜检查纳入妇科住院医师培训是否能提供足够的经验，使住院医师毕业后获得医院授予的资质。
我们制定了一项课程，培训住院医师对潜在下尿路损伤进行术中膀胱镜检查评估。在进行子宫切除术时，根据指征进行膀胱镜检查，在盆腔重建手术中则常规进行。教员通过口试和在手术室直接观察来评估住院医师的理论知识和技术熟练程度。一旦住院医师在进行术中膀胱镜检查方面表现出透彻的理解和熟练的操作能力，项目主任就会颁发一份能力认证文件。该认证文件会转交给住院医师毕业后所在医院的资质审查委员会，以证明授予其相应权限的合理性。
自1994年以来，在主要的妇科腹部和阴道手术中已进行了400多次经尿道膀胱镜检查评估，自1997年以来，在选定的腹部病例中又额外进行了50次经膀胱微膀胱镜检查。25名住院医师毕业生已获得在术中诊断性膀胱镜检查方面的全面培训认证。所有这些毕业生在随后的医院工作中都被授予了术中膀胱镜检查的权限。
将膀胱镜尿路评估纳入常规妇科手术培训是良好的医疗实践，并提供了一种机制，使妇产科住院医师毕业后能够获得术中膀胱镜检查的医院权限。（《妇产科学》2000年；96:1014 - 7）
