Foley P J, Roses R E, Kelz R R, Resnick A S, Williams N N, Mullen J L, Kaiser L R, Morris Jon B
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
J Surg Educ. 2008 Nov-Dec;65(6):494-8. doi: 10.1016/j.jsurg.2008.04.001.
Much has been written about the influences of Accreditation Council for Graduate Medical Education (ACGME) work restrictions, the litigious climate in American medicine, and the proliferation of subspecialty fellowships on general surgery training. Few previous studies have addressed general surgical residents' perceptions of surgical training on a national level.
A 38-question Institutional Review Board-approved survey was sent via e-mail to the program directors at all ACGME-approved general surgical training programs for distribution to categorical general surgery residents. Voluntary responses to statements focusing on job satisfaction, quality of life, and the influences of operative experience, work hours, fellows, physician extenders, as well as faculty and administration on resident training were solicited.
Overall, 997 responses were received from residents of all clinical levels from 40 states. Most respondents were from university-based programs (79%) with a broad representation of program sizes (mean of 6 graduates per year; range 2 to 11). Residents believe that they will be prepared to enter clinical practice at the conclusion of their training (86%), that the duration of surgical training is adequate (85%), and that they are exposed to sufficient case volume and complexity (85% and 84%, respectively). Only 360 respondents (36%) believe that they are financially compensated appropriately. Although most respondents support the ACGME work-hour restrictions (70%), far fewer feel that they improve their training or patient care (46.6% and 46.8%, respectively). Most respondents are proud to be surgical residents (88%), view surgery as a rewarding profession (87%), and would choose surgery as a profession again (77%).
Surgical residents are positive regarding the quality of their training and life, although they feel poorly compensated for their work. Most residents intend to pursue fellowship training. Survey responses were consistent irrespective of gender, ethnicity, and program type.
关于毕业后医学教育认证委员会（ACGME）的工作限制、美国医学领域的诉讼环境以及亚专科 fellowship 的激增对普通外科培训的影响，已有大量相关著述。此前很少有研究在全国范围内探讨普通外科住院医师对手术培训的看法。
一项经机构审查委员会批准的包含 38 个问题的调查问卷通过电子邮件发送给所有 ACGME 批准的普通外科培训项目的项目主任，以便分发给普通外科住院医师。征集了对关于工作满意度、生活质量以及手术经验、工作时长、专科住院医师、医师助理以及教员和行政部门对住院医师培训影响等陈述的自愿回复。
总体而言，从 40 个州的各级临床住院医师那里收到了 997 份回复。大多数受访者来自大学附属医院项目（79%），项目规模具有广泛代表性（平均每年毕业 6 人；范围为 2 至 11 人）。住院医师认为他们在培训结束时将为进入临床实践做好准备（86%），手术培训时长足够（85%），并且他们接触到了足够的病例数量和复杂程度（分别为 85%和 84%）。只有 360 名受访者（36%）认为他们得到了适当的经济补偿。尽管大多数受访者支持 ACGME 的工作时长限制（70%），但远 fewer 人认为这些限制改善了他们的培训或患者护理（分别为 46.6%和 46.8%）。大多数受访者为自己是外科住院医师而感到自豪（88%），将外科视为一项有意义的职业（87%），并且会再次选择外科作为职业（77%）。
外科住院医师对他们的培训质量和生活持积极态度，尽管他们觉得自己的工作报酬很低。大多数住院医师打算继续接受专科培训。无论性别、种族和项目类型如何，调查回复都是一致的。
