Babineau Timothy J, Becker James, Gibbons Gary, Sentovich Stephen, Hess Donald, Robertson Sharon, Stone Michael
Departments of Surgery, Boston Medical Center, Quincy Medical Center, and Boston University School of Medicine, Boston, Mass. 02118, USA.
Arch Surg. 2004 Apr;139(4):366-9; discussion 369-70. doi: 10.1001/archsurg.139.4.366.
There is an increase in the amount of time required to perform an operation when the procedure involves training a surgical resident. This increased time does not translate into a financial burden for the hospital.
Retrospective review of prospectively collected data. During the study period, surgeons and residents were blinded to the study's intent. We compared the operative times of academic surgeons performing 4 common surgical procedures before and after the introduction of a postgraduate year 3 resident into a community teaching hospital. Between January 1, 2001, and June 30, 2002, 4 academic surgeons performed operations without a resident in a community hospital that was recently integrated into a tertiary medical center system. During that period, surgeons operated alone (hernia surgery) or assisted one another (laparoscopic cholecystectomy, colectomy, and carotid endarterectomy). From July 1, 2002, through March 31, 2003, these same 4 surgeons were assisted by a postgraduate year 3 resident on similar procedures.
Community hospital recently integrated into a tertiary medical center system.
Four experienced academic surgeons operating in the community setting and patients undergoing 1 of 4 surgical procedures (inguinal hernia repair, laparoscopic cholecystectomy, partial colectomy, or carotid endarterectomy) from January 1, 2001, through March 31, 2003.
The introduction of a postgraduate year 3 surgical resident rotation into a community hospital in which the same academic surgeons had been performing operations without a resident for 18 months.
Mean operating time with and without a postgraduate year 3 resident participating in 4 common surgical procedures. Result For the 4 procedures studied, there was a significant increase in the operative time required to complete such procedures.
There is an increased time cost associated with the operative training of surgical residents. This "cost" primarily impacts the attending surgeon.
当手术过程涉及培训外科住院医师时，完成手术所需的时间会增加。但这种增加的时间不会给医院带来经济负担。
对前瞻性收集的数据进行回顾性分析。在研究期间，外科医生和住院医师对研究目的不知情。我们比较了在社区教学医院引入三年级住院医师前后，学术外科医生进行4种常见外科手术的手术时间。2001年1月1日至2002年6月30日期间，4名学术外科医生在一家最近并入三级医疗中心系统的社区医院进行无住院医师参与的手术。在此期间，外科医生独自手术（疝气手术）或互相协助（腹腔镜胆囊切除术、结肠切除术和颈动脉内膜切除术）。从2002年7月1日至2003年3月31日，这4名相同的外科医生在类似手术中由一名三年级住院医师协助。
最近并入三级医疗中心系统的社区医院。
2001年1月1日至2003年3月31日期间，在社区环境中手术的4名经验丰富的学术外科医生以及接受4种外科手术（腹股沟疝修补术、腹腔镜胆囊切除术、部分结肠切除术或颈动脉内膜切除术）之一的患者。
将三年级外科住院医师轮转引入一家社区医院，在该医院，相同的学术外科医生在无住院医师参与的情况下已经进行了18个月的手术。
三年级住院医师参与和不参与4种常见外科手术时的平均手术时间。结果：对于所研究的4种手术，完成这些手术所需的手术时间显著增加。
外科住院医师的手术培训存在时间成本增加的情况。这种“成本”主要影响主刀医生。
