Kothari Shanu N, Cogbill Thomas H, O'Heron Colette T, Mathiason Michelle A
Department of Surgery, Gundersen Lutheran Health System, La Crosse, Wisconsin 54601, USA.
J Surg Educ. 2008 Nov-Dec;65(6):393-6. doi: 10.1016/j.jsurg.2008.04.008.
Concern has been voiced that general surgery residents who train at institutions that also offer advanced laparoscopic fellowships may receive inadequate advanced laparoscopic operative experience. The purpose of our study was to compare the operative experience of general surgery residents who graduated from our institution before initiation of an advanced laparoscopic fellowship with the experience of those who graduated after the fellowship began.
Operative case logs of surgery residents who graduated from 2000 through 2007 and of advanced laparoscopic fellows from 2004 through 2007 were reviewed. Surgery resident experience with basic and nonbariatric advanced laparoscopic cases during the 4 years before the fellowship was compared with the experience during the 4 years after the fellowship began.
Residents who graduated before 2004 performed a mean of 140.5 +/- 19.4 basic and 77.0 +/- 17.8 advanced laparoscopic cases during their 5-year residency, compared with 193.3 +/- 34.5 basic (p = 0.003) and 113.3 +/- 23.5 advanced cases (p = 0.005) performed by those who graduated in 2004 or later. The number of nonbariatric advanced laparoscopic cases performed by each graduating surgical resident during the chief year ranged from 26 to 47 cases from 2000 to 2003 and from 36 to 69 cases from 2004 to 2007. Fellows reported from 40 to 85 nonbariatric advanced laparoscopic cases annually.
General surgery residents did not experience a reduction in the total number of basic and nonbariatric advanced laparoscopic cases with the addition of an advanced laparoscopic fellowship, nor did they perform fewer cases during the chief year. As the result of a cooperative venture between the surgery residency and fellowship directors as well as an expansion of the total number of laparoscopic cases performed at our institution because of changes in clinical practice, surgery residents reported an increase in the number of laparoscopic cases while a successful fellowship was established.
有人担心，在同时提供高级腹腔镜专科培训的机构中接受培训的普通外科住院医师可能无法获得足够的高级腹腔镜手术经验。我们研究的目的是比较在高级腹腔镜专科培训开始之前从我们机构毕业的普通外科住院医师的手术经验与在该专科培训开始之后毕业的住院医师的经验。
回顾了2000年至2007年毕业的外科住院医师以及2004年至2007年高级腹腔镜专科培训学员的手术病例记录。将专科培训开始前4年普通外科住院医师在基础和非减重高级腹腔镜手术方面的经验与专科培训开始后4年的经验进行比较。
2004年之前毕业的住院医师在其5年住院医师培训期间平均完成了140.5±19.4例基础腹腔镜手术和77.0±17.8例高级腹腔镜手术，而2004年或之后毕业的住院医师完成了193.3±34.5例基础手术（p = 0.003）和113.3±23.5例高级手术（p = 0.005）。2000年至2003年期间，每位毕业的外科住院医师在担任主治医生的那一年中进行的非减重高级腹腔镜手术病例数为26至47例，2004年至2007年为36至69例。专科培训学员每年报告的非减重高级腹腔镜手术病例数为40至85例。
增加高级腹腔镜专科培训后，普通外科住院医师的基础和非减重高级腹腔镜手术病例总数并未减少，在担任主治医生的那一年中进行的病例数也没有减少。由于外科住院医师培训项目和专科培训项目主任之间的合作，以及由于临床实践的变化，我们机构进行的腹腔镜手术总数有所增加，普通外科住院医师报告的腹腔镜手术病例数增加，同时成功设立了专科培训项目。
