Bittner James G, Coverdill James E, Imam Toufic, Deladisma Adeline M, Edwards Michael A, Mellinger John D
Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia 30912, USA.
J Surg Educ. 2008 Nov-Dec;65(6):418-30. doi: 10.1016/j.jsurg.2008.05.001.
Many modifications to the traditional residency model contribute to the ongoing paradigm shift in surgical education; yet, the frequency and manner by which such changes occur at various institutions is less clear. To address this issue, our study examined the variability in endoscopy and laparoscopy training, the potential impact of new requirements, and opinions of Program Directors in Surgery (PDs).
A 22-item online survey was sent to 251 PDs in the United States. Appropriate parametric tests determined significance.
In all, 105 (42%) PDs responded. No difference existed in response rates among university (56.2%), university-affiliated/community (30.5%), or community (13.3%) program types (p = 0.970). Surgeons alone (46.7%) conducted most endoscopy training with a trend toward multidisciplinary teams (43.8%). A combination of fellowship-trained minimally invasive surgeons and other surgeon types (66.7%) commonly provided laparoscopy training. For adequate endoscopy experience in the future, most PDs (74.3%) plan to require a formal flexible endoscopy rotation (p < 0.001). For laparoscopy, PDs intend for more minimally invasive surgery (59%) as well as colon and rectal surgery (53.4%) rotations (both p < 0.001). Respondents feel residents will perform diagnostic endoscopy (86.7%) and basic laparoscopy (100%) safely on graduation. Fewer PDs confirm graduates will safely practice therapeutic endoscopy (12.4%) and advanced laparoscopy (52.4%). PDs believe increased requirements for endoscopy and laparoscopy will improve procedural competency (79% and 92.4%, respectively) and strengthen the fields of surgical endoscopy and minimally invasive surgery (55.2% and 68.6%, respectively). Less believe new requirements necessitate redesign of cognitive and technical skills curricula (33.3% endoscopy, 28.6% laparoscopy; p = 0.018). A national surgical education curriculum should be a required component of resident training, according to 79% of PDs.
PDs employ and may implement varied tools to meet the increased requirements in endoscopy and laparoscopy. With such variability in educational methodology, establishment of a national surgical education curriculum is very important to most PDs.
对传统住院医师培训模式的诸多改进促成了外科教育领域正在进行的范式转变；然而，这些变化在不同机构发生的频率和方式尚不清楚。为解决这一问题，我们的研究考察了内镜检查和腹腔镜检查培训的差异、新要求的潜在影响以及外科项目主任（PD）的意见。
向美国251名PD发送了一份包含22个项目的在线调查问卷。采用适当的参数检验确定显著性。
共有105名（42%）PD做出回应。大学项目（56.2%）、大学附属医院/社区项目（30.5%）或社区项目（13.3%）的回应率无差异（p = 0.970）。大多数内镜检查培训由外科医生单独进行（46.7%），且有向多学科团队发展的趋势（43.8%）。接受过专科培训的微创外科医生和其他外科医生类型的组合（66.7%）通常提供腹腔镜检查培训。对于未来获得足够的内镜检查经验，大多数PD（74.3%）计划要求进行正式的可弯曲内镜检查轮转（p < 0.001）。对于腹腔镜检查，PD希望增加更多的微创手术（59%）以及结肠和直肠手术（53.4%）的轮转（两者p < 0.001）。受访者认为住院医师毕业后将能够安全地进行诊断性内镜检查（86.7%）和基本腹腔镜检查（100%）。较少有PD确认毕业生将能够安全地进行治疗性内镜检查（12.4%）和高级腹腔镜检查（52.4%）。PD认为增加内镜检查和腹腔镜检查的要求将提高操作能力（分别为79%和92.4%），并加强外科内镜检查和微创手术领域（分别为55.2%和68.6%）。较少有人认为新要求需要重新设计认知和技术技能课程（内镜检查为33.3%，腹腔镜检查为28.6%；p = 0.018）。79%的PD认为全国性的外科教育课程应该是住院医师培训的必需组成部分。
PD采用并可能实施各种工具来满足内镜检查和腹腔镜检查方面增加的要求。鉴于教育方法存在如此差异，对大多数PD来说，建立全国性的外科教育课程非常重要。
