Mahendran S, Bennett A M D, Jones S E M, Young B A, Prinsley P R
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.
J Laryngol Otol. 2006 Mar;120(3):193-9. doi: 10.1017/S0022215105006365. Epub 2005 Dec 5.
A prospective audit of specialist registrars' (SRs') training in tympanomastoid surgery for chronic otitis media within the Anglia Regional Training Scheme is described. This audit recorded the surgical activity of the trainees and their contribution to operative procedures, and assessed the results of the procedures. This type of systematic approach to the audit of surgical training is important in light of the current shortened training programmes and increased accountability of trainers.
The study aimed to establish the levels of exposure to, supervision of and outcome of ear operations for chronic otitis media performed by ENT trainees in the East Anglia region.
A prospective, region-wide, minimum otology dataset-based proforma audit was undertaken, with compulsory SR participation. Proformas were completed at the time of operation (form one) and at a minimum interval of nine months post-operatively (form two). Data on form one included hospital, supervising consultant, name and training year of SR, contribution of SR (based on England Royal College of Surgeons guidelines interpreted by the SR), pre-operative audiology average (air conduction/bone conduction over 0.5, 1, 2 and 4 kHz), the pathology and the state of the ear at the time of surgery, and a breakdown of the procedure(s) undertaken. Form two recorded data relevant to form one as well as information regarding patient satisfaction and the operative result obtained, graded as 'gold' (no disease, dry ear and hearing average < 25 dB), 'silver' (two of these three) and 'bronze' (one of these three). All completed forms were analysed using Microsoft Access software.
Completed copies of 409 form ones and 156 form twos were analysed. With advancing years, SRs' contributions to procedures increased without significant effect on the graded outcome, which appeared to be independent of SR year of training. Different regional hospitals were compared. Data collected also provided an otology training portfolio for SRs, forming part of their registrar in-training assessment (RITA).
The East Anglia SR audit of SRs' training in tympanomastoid surgery for chronic otitis media was a powerful training tool. It demonstrated the safe progression of SR training in supervised ear surgery, with SRs' results being comparable to those for consultant-performed procedures.
本文描述了在安格利亚地区培训计划内对专科住院医师（SR）慢性中耳炎鼓室乳突手术培训的前瞻性审计。该审计记录了学员的手术活动及其对手术操作的贡献，并评估了手术结果。鉴于当前培训计划缩短以及培训人员问责制增加，这种系统的手术培训审计方法很重要。
本研究旨在确定东安格利亚地区耳鼻喉科（ENT）学员进行的慢性中耳炎耳部手术的接触水平、监督情况和手术结果。
进行了一项基于地区范围、以最低耳科学数据集为基础的前瞻性表格审计，SR必须参与。表格在手术时（表格一）以及术后至少九个月时（表格二）填写。表格一的数据包括医院、指导顾问、SR的姓名和培训年份、SR的贡献（基于英国皇家外科医学院指南并由SR解读）、术前平均听力（0.5、1、2和4kHz的气导/骨导）、手术时的病理情况和耳部状态，以及所进行手术的详细分类。表格二记录了与表格一相关的数据以及患者满意度和手术结果的信息，分为“金牌”（无疾病、干耳且平均听力<25dB）、“银牌”（这三项中的两项）和“铜牌”（这三项中的一项）。所有填写完整的表格都使用Microsoft Access软件进行分析。
分析了409份表格一和156份表格二的完整副本。随着年份的增加，SR对手术操作的贡献增加，但对分级结果没有显著影响，分级结果似乎与SR的培训年份无关。对不同的地区医院进行了比较。收集的数据还为SR提供了一个耳科学培训档案，构成其住院医师培训评估（RITA）的一部分。
东安格利亚地区对SR慢性中耳炎鼓室乳突手术培训的审计是一个强大的培训工具。它展示了在有监督的耳部手术中SR培训的安全进展，SR的手术结果与顾问医生进行的手术结果相当。
