Guo Lifei, Friend Judith, Kim Edward, Lipsitz Stuart, Orgill Dennis P, Pribaz Julian
Boston and Cambridge, Mass. From the Harvard Plastic Surgery Residency Training Program, the Division of Plastic Surgery and the Center for Surgery and Public Health, Brigham & Women's Hospital, and Harvard College.
Plast Reconstr Surg. 2008 Sep;122(3):972-978. doi: 10.1097/PRS.0b013e3181811c6d.
The purpose of this study was to compare residents in the integrated and independent tracks of plastic surgery residency training using several quantitative educational metrics. The Harvard Combined Plastic Surgery Residency Training Program offers an ideal model for this comparison, as it is the largest in the country and operates both tracks simultaneously.
The authors compared several quantitative educational metrics of all 22 independent and 24 integrated residents matched into the Harvard Program since its inception. These quantitative educational metrics include medical school reputation, United States Medical Licensing Examination (USMILE, Philadelphia, Pa.) step 1 scores, publication productivities during different educational periods (preresidency and pre-plastic surgery training), in-service scores, exit rankings (overall and operative skills), and percentage of M.D./Ph.D. residents.
Integrated residents graduated from more highly ranked medical schools than independent residents (mean tier, 1.5 versus 2.3; p = 0.0345), had higher United States Medical Licensing Examination step 1 scores (mean, 235 versus 220; p = 0.0234), and had higher preresidency publication scores (mean, 68 versus 14; p = 0.015). There are more M.D./Ph.D. residents in the integrated than in the independent track (33.3 percent versus 4.4 percent; p = 0.027). Independent residents had higher pre-plastic surgery training publication scores (mean, 77 versus 6; p = 0.0003). In-training quantitative educational metrics were similar between the two tracks (p > 0.05 in all cases). To address potential caveats of the study, all publication scores were compared with and without correction for the presence of M.D./Ph.D. residents, which yielded similar results. The authors also compared the match ranks of all their residents and found them to be statistically comparable between the two tracks.
In the Harvard Program, the integrated residents had better preresidency quantitative educational metrics, whereas the independent residents had better pre-plastic surgery training quantitative educational metrics. In training quantitative educational metrics were remarkably similar between the two tracks. In conclusion, this study, a systematic comparison between the two tracks, offers not only a valid foundation for future study of long-term outcome results but also a starting point from which to improve on the educational experience of residents in either track.
本研究旨在使用多种定量教育指标比较整形外科住院医师培训中综合培养路径和独立培养路径的住院医师。哈佛联合整形外科住院医师培训项目为此比较提供了理想模型，因为它是美国规模最大且同时开展这两种培养路径的项目。
作者比较了自哈佛项目设立以来匹配到该项目的所有22名独立培养和24名综合培养住院医师的多项定量教育指标。这些定量教育指标包括医学院声誉、美国医师执照考试（USMLE，宾夕法尼亚州费城）第一步考试成绩、不同教育阶段（住院医师培训前和整形外科培训前）的发表成果、在职培训成绩、结业排名（总体和手术技能）以及医学博士/哲学博士住院医师的比例。
综合培养的住院医师毕业于排名比独立培养住院医师更高的医学院（平均排名等级，1.5 对 2.3；p = 0.0345），美国医师执照考试第一步成绩更高（平均成绩，235 对 220；p = 0.0234），住院医师培训前的发表得分更高（平均成绩，68 对 14；p = 0.015）。综合培养路径中的医学博士/哲学博士住院医师比独立培养路径中的更多（33.3% 对 4.4%；p = 0.027）。独立培养的住院医师在整形外科培训前的发表得分更高（平均成绩，77 对 6；p = 0.0003）。两种培养路径的在职培训定量教育指标相似（所有情况 p > 0.05）。为解决本研究的潜在问题，所有发表得分在考虑和不考虑医学博士/哲学博士住院医师存在的情况下进行了比较，结果相似。作者还比较了所有住院医师的匹配排名，发现两种培养路径在统计学上具有可比性。
在哈佛项目中，综合培养的住院医师在住院医师培训前的定量教育指标更好，而独立培养的住院医师在整形外科培训前的定量教育指标更好。两种培养路径的在职培训定量教育指标非常相似。总之，本研究对两种培养路径进行了系统比较，不仅为未来长期结果研究提供了有效基础，也为改善任一培养路径住院医师的教育体验提供了一个起点。
