McFadden Cedrek L, Cobb William S, Lokey Jonathan S, Cull David L, Smith Dane E, Taylor Spence M
Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina 29605, USA.
J Surg Educ. 2007 Nov-Dec;64(6):420-3. doi: 10.1016/j.jsurg.2007.06.013.
As laparoscopy continues to permeate general surgery, there is an increased need for residents to acquire advanced laparoscopic skills during a surgical training program. To underscore its importance, the Accreditation Council of Graduate Medical Education (ACGME) recently increased the requirements for laparoscopy from 34 to 60 basic cases and from 0 to 25 advanced cases. With this in mind, the purpose of this study is to assess the impact of an organized minimally invasive surgical service on the volume of advanced laparoscopic cases of a general surgery residency program.
In July 2005 an independent minimally invasive surgical service, consisting of a fellowship-trained laparoscopic surgeon and 3 general surgery residents was instituted in an otherwise stable academic general surgery residency program. A retrospective review of the general resident's operative database was performed from 2001 to 2006 to assess the impact of this service on the volume of advanced laparoscopic cases of graduating chief residents.
In the 4 years before the initiation of the minimally invasive service, the operative volume remained flat despite a stable training program and steady population growth. In the year after the formation of the dedicated service, the mean number of advanced cases performed by the graduating chief residents more than doubled, from 17.7 cases in each of the 2 years before, to 35.6 cases, fulfilling the ACGME requirements.
The number of advanced laparoscopic cases per resident in this otherwise stable general surgery residency program substantially increased with the incorporation of a dedicated minimally invasive service led by a fellowship-trained laparoscopic surgeon. These data suggest that the volume increases needed to satisfy ACGME requirements may only be possible by creation of such a training experience dedicated to advanced laparoscopy.
随着腹腔镜技术在普通外科的不断普及，外科住院医师在手术培训项目中掌握先进腹腔镜技术的需求日益增加。为强调其重要性，毕业后医学教育认证委员会（ACGME）最近将腹腔镜技术的要求从34个基础病例增加到60个，从0个高级病例增加到25个。鉴于此，本研究旨在评估有组织的微创手术服务对普通外科住院医师培训项目中高级腹腔镜病例数量的影响。
2005年7月，在一个原本稳定的学术性普通外科住院医师培训项目中设立了一个独立的微创手术服务团队，由一名接受过专科培训的腹腔镜外科医生和3名普通外科住院医师组成。对2001年至2006年住院医师的手术数据库进行回顾性分析，以评估该服务对即将毕业的总住院医师所做高级腹腔镜病例数量的影响。
在开展微创手术服务的前4年，尽管培训项目稳定且人口稳步增长，但手术量保持平稳。在专门服务团队组建后的一年，即将毕业的总住院医师所做的高级病例平均数量增加了一倍多，从之前两年每年的17.7例增至35.6例，达到了ACGME的要求。
在这个原本稳定的普通外科住院医师培训项目中，由接受过专科培训的腹腔镜外科医生领导的专门微创手术服务的引入，显著增加了每位住院医师的高级腹腔镜病例数量。这些数据表明，只有通过创建这种专注于高级腹腔镜技术的培训经验，才有可能增加手术量以满足ACGME的要求。
