Durkin Emily Tompkins, McDonald Robert, Munoz Alejandro, Mahvi David
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
J Surg Educ. 2008 Jan-Feb;65(1):54-60. doi: 10.1016/j.jsurg.2007.08.008.
Resident work-hour restrictions were instituted in July 2003 based on ACGME mandates. The American Board of Surgery In-Training Examination (ABSITE), American Board of Surgery Qualifying Examination (ABSQE), and operative volume traditionally have been measures of surgical resident education and competency. The objective of this study was to determine the effect of reduced work hours on resident standardized test scores and operative volume at our institution.
We reviewed ABSITE scores, ABSQE scores, and operative logs from 1997 to 2005 of all general surgery residents. Linear mixed-effects models were fitted for each component ABSITE score (total, basic science, and clinical management), and they were compared using a chi-squared likelihood ratio. Operative logs of graduating residents were compared before and after the work restrictions and were evaluated for association with ABSITE score. p-values less than 0.05 were considered significant.
The program was compliant with ACGME mandates within 6 months of institution. ABSITE scores improved significantly after the restriction of work hours in both basic science (p = 0.003) and total score (p = 0.008). Clinical management scores were not affected. The number of major cases recorded by graduating residents did not change. A positive correlation was found between number of cases performed during residency and clinical management ABSITE scores (p = 0.045). ABSQE scores were not impacted by operative volume during residency.
ABSITE scores improved significantly after the restriction of resident work hours. Resident operative experience was not affected. An unexpected consequence of work-hour restrictions may be an improvement in surgical resident education.
根据美国研究生医学教育认证委员会（ACGME）的要求，2003年7月开始实施住院医师工作时间限制。美国外科委员会住院医师培训考试（ABSITE）、美国外科委员会资格考试（ABSQE）以及手术量一直以来都是衡量外科住院医师教育水平和能力的指标。本研究的目的是确定减少工作时间对我院住院医师标准化考试成绩和手术量的影响。
我们回顾了1997年至2005年所有普通外科住院医师的ABSITE成绩、ABSQE成绩和手术记录。对每个ABSITE分项成绩（总分、基础科学和临床管理）拟合线性混合效应模型，并使用卡方似然比进行比较。比较了工作限制前后毕业住院医师的手术记录，并评估其与ABSITE成绩的相关性。p值小于0.05被认为具有统计学意义。
该项目在实施后的6个月内符合ACGME的要求。工作时间限制后，基础科学（p = 0.003）和总分（p = 0.008）的ABSITE成绩显著提高。临床管理成绩未受影响。毕业住院医师记录的大手术数量没有变化。住院期间完成的病例数与临床管理ABSITE成绩之间存在正相关（p = 0.045）。住院期间的手术量对ABSQE成绩没有影响。
限制住院医师工作时间后，ABSITE成绩显著提高。住院医师的手术经验未受影响。工作时间限制的一个意外结果可能是外科住院医师教育水平的提高。
