McGuigan Rebecca Marier, Beitler Alan L
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
Curr Surg. 2002 May-Jun;59(3):307-12. doi: 10.1016/s0149-7944(01)00638-9.
Over the past decade, the Army Medical Department (AMEDD) has been affected by a military-wide drawdown. The volume and acuity of patients appears to be declining, raising questions regarding quantity and quality in Army surgical training programs. The purpose of this study is to examine the caseloads of Army general surgery programs compared with national averages, and to compare the board examination performance of Army residents with national pass rates.
The program directors of all 6 Army training programs were requested to submit resident caseloads and performance on qualifying and certifying examinations from 1990 to 2000. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery (ABS) provided resident statistics summaries and board examination statistics, respectively, for the same period. Total caseloads, chief resident cases, performance in defined categories, and board pass rates of military residents were compared with national averages.
Four of the 6 programs submitted the requested data. The average caseload for Army residents, both total and chief residents, has been lower than the national average over the past decade. Nationally, total case numbers have gradually increased while military changes have been variable. The number of chief resident cases has trended steadily downward in Army programs at a rate exceeding the national average. The volume of procedures in endoscopy, thoracic, and breast surgery in the Army generally exceeds those recorded outside of the military. Despite the decline in surgical cases in the military, the pass rates in both the certifying and qualifying examinations among Army graduates have been consistently higher than the national average.
Residents who train in Army programs perform fewer operative cases than do their counterparts in civilian programs. The downward trend in the number of chief resident cases over the last 10 years is likely reflective of the changes in military medicine. Despite these trends, Army residency graduates continue to exceed national performance averages on the ABS qualifying and certifying examinations.
在过去十年中，陆军医务部（AMEDD）受到全军规模缩减的影响。患者数量和病情严重程度似乎在下降，这引发了关于陆军外科培训项目数量和质量的问题。本研究的目的是将陆军普通外科项目的病例数量与全国平均水平进行比较，并将陆军住院医师的委员会考试成绩与全国通过率进行比较。
要求所有6个陆军培训项目的项目主任提交1990年至2000年住院医师的病例数量以及资格考试和认证考试成绩。研究生医学教育认证委员会（ACGME）和美国外科委员会（ABS）分别提供了同期住院医师统计摘要和委员会考试统计数据。将军事住院医师的总病例数、总住院医师病例数、特定类别中的表现以及委员会通过率与全国平均水平进行比较。
6个项目中有4个提交了所需数据。在过去十年中，陆军住院医师（包括总住院医师和首席住院医师）的平均病例数量低于全国平均水平。在全国范围内，总病例数逐渐增加，而军队中的情况则有所不同。陆军项目中首席住院医师的病例数呈稳步下降趋势，下降速度超过全国平均水平。陆军在内窥镜、胸科和乳腺外科手术的数量通常超过军队外记录的数量。尽管军队中的外科病例有所减少，但陆军毕业生在认证考试和资格考试中的通过率一直高于全国平均水平。
在陆军项目中接受培训的住院医师进行的手术病例比民用项目中的同行少。过去10年中首席住院医师病例数的下降趋势可能反映了军事医学的变化。尽管有这些趋势，陆军住院医师毕业生在ABS资格考试和认证考试中的成绩仍继续超过全国平均水平。
