Cuschieri A, Francis N, Crosby J, Hanna G B
Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, Dundee, Scotland, UK.
Am J Surg. 2001 Aug;182(2):110-6. doi: 10.1016/s0002-9610(01)00667-5.
There has been on-going debate and public interest in surgical competence in recent years.
A Delphi reiterative opinion survey was conducted among master surgeons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons.
Selection-the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality. Important aspects of personality include decision-making ability, insight, team spirit, and emotional stability. Assessment during training-the majority view was that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged but academic achievement does not reflect surgical competence. There was a majority verdict for an exit clinical examination. Revalidation-the group agreed on the need for competence checks during the professional career of surgeons. These should cover knowledge, clinical, operative, and humanistic skills; but expressed concern on the feasibility of a revalidation system that can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External assessment by nationally appointed 'assessors' was considered preferable.
Both selection and assessment of surgical trainees require changes and standardization. Although revalidation is necessary, concern was expressed on the reliability and validity of existing and proposed systems.
近年来，关于外科手术能力一直存在持续的争论和公众关注。
针对主刀医生开展了一项德尔菲反复意见调查，内容涉及外科实习医生的选拔、实习医生进展评估方法以及资深顾问外科医生的重新认证。
选拔——目前的实习医生选拔方法被认为不充分，需要修订。该小组认可的重要属性包括认知因素、天生的灵巧性和个性。个性的重要方面包括决策能力、洞察力、团队精神和情绪稳定性。培训期间的评估——多数观点认为，这应基于临床判断/技能、手术技能和认知能力。技术能力评估应基于标准化清单。鼓励在培训项目中开展研究，但学术成就并不能反映手术能力。对于结业临床考试存在多数裁定。重新认证——该小组一致认为，在外科医生的职业生涯中需要进行能力检查。这些检查应涵盖知识、临床、手术和人文技能；但对能够可靠评估手术能力所需技能范围的重新认证系统的可行性表示担忧。多数投票反对内部评估系统。由国家指定的“评估者”进行外部评估被认为更可取。
外科实习医生的选拔和评估都需要变革和标准化。虽然重新认证是必要的，但对现有和提议系统的可靠性和有效性表示了担忧。
