Joyner Byron D, Siedel Kristy, Stoll Doris, Mitchell Michael
Urology Program, The University of Washington, Division of Pediatric Urology, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
J Urol. 2005 Nov;174(5):1961-8; discussion 1968. doi: 10.1097/01.ju.0000177468.30135.ff.
Residency programs in the United States are held accountable for achieving outcomes based on the new Accreditation Council for Graduate Medical Education (ACGME) regulations for improving resident fatigue and education. A national survey of Urology Program Directors was conducted to determine the attitudes toward the new regulations and the actions taken to implement them.
A national survey was developed by an ad hoc committee and distributed electronically. A total of 24 multiple-choice customized Likert scale questions were used to obtain opinions from Urology Program Directors across the country. The data were evaluated using statistical analysis.
There was an 88% response rate to the survey. Of the respondents 53% demonstrated a statistically significant association between the size of the program and the degree to which the program was involved in addressing the duty hours standard (p = 0.015). A majority of program directors reported involvement in educating residents and faculty about the ACGME competencies. According to program directors, faculty members were negative about training residents in an 80-hour workweek and residents seemed to be apathetic.
The national survey of Urology Program Directors has demonstrated that most programs have started to attend to the cultural change occurring in GME. Although there are some pockets of resistance to the ACGME regulations, the duty hours have been folded into most programs with little apprehension. Barriers to implementation of the Core Competencies discovered in this survey included inadequate validated instrumentation, inadequate staffing, and insufficient financial support.
根据研究生医学教育认证委员会（ACGME）关于改善住院医师疲劳和教育的新规定，美国的住院医师培训项目需对取得的成果负责。我们对泌尿外科项目主任进行了一项全国性调查，以确定他们对新规定的态度以及为实施这些规定所采取的行动。
一个特别委员会制定了一项全国性调查，并通过电子方式分发。总共使用了24个定制的多项选择李克特量表问题，以获取全国各地泌尿外科项目主任的意见。对数据进行统计分析。
调查的回复率为88%。在受访者中，53%的人表明项目规模与项目参与解决工作时长标准的程度之间存在统计学上的显著关联（p = 0.015）。大多数项目主任报告参与了对住院医师和教职员工进行ACGME能力方面的教育。根据项目主任的说法，教职员工对按每周80小时工作周培训住院医师持消极态度，而住院医师似乎无动于衷。
对泌尿外科项目主任的全国性调查表明，大多数项目已开始关注毕业后医学教育中正在发生的文化变革。尽管对ACGME规定存在一些抵触情况，但工作时长已被纳入大多数项目，且几乎没有担忧。本次调查中发现的核心能力实施障碍包括缺乏经过验证的工具、人员配备不足和资金支持不足。
