Suwanabol P Amy, McDonald Robert, Foley Eugene, Weber Sharon M
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792-7375, USA.
J Surg Res. 2009 Oct;156(2):240-4. doi: 10.1016/j.jss.2009.04.017. Epub 2009 May 14.
The Accreditation Council for Graduate Medical Education (ACGME) has placed great emphasis on residents learning to identify their training needs and to develop learning strategies to address these needs. In surgery, residents can play an active role in identifying training needs through self-assessment of their procedural skills. Our study contributes to the growing body of literature regarding practice-based learning and improvement by attempting to determine if surgery resident experience is associated with comfort level and perceived training needs.
Twenty-five general surgery residents completed a surgical experience survey, which asked them to indicate the range of times they performed a procedure, their comfort level in performing the procedure, and the quality of training they felt they received. Residents were given a survey with cases appropriate for their postgraduate year. A Cochran-Armitage trend test was used to evaluate the trends between comfort level and experience, and training needs and experience. A P value of 0.05 was considered statistical significance in all analyses.
Resident comfort level demonstrated a positive trend compared with case volume both in the self-reported survey and ACGME case log (P values<0.001). Additionally, higher levels of training were associated with increased comfort level (P value=0.05). Perceived training needs and experience were also associated (P value<0.001), demonstrating that with increased experience, residents felt that their training needs were being met.
Our study demonstrates that residents are able to assess their comfort level and training needs based on both actual and perceived experience. The procedural survey has been a useful tool for resident self-assessment in that residents are able to play a more active role in their education by developing appropriate learning plans.
毕业后医学教育认证委员会（ACGME）非常重视住院医师学会识别自身培训需求并制定学习策略以满足这些需求。在外科领域，住院医师可以通过自我评估手术技能在识别培训需求方面发挥积极作用。我们的研究试图确定外科住院医师的经验是否与舒适度及感知到的培训需求相关，从而为关于基于实践的学习与改进的文献增添内容。
25名普通外科住院医师完成了一项手术经验调查，该调查要求他们指出自己进行某项手术的次数范围、进行该手术时的舒适度以及他们认为所接受培训的质量。根据住院医师的研究生年级，为他们提供了包含相应病例的调查问卷。采用 Cochr an-Armitage趋势检验来评估舒适度与经验之间以及培训需求与经验之间的趋势。在所有分析中，P值小于0.05被视为具有统计学意义。
在自我报告的调查和ACGME病例记录中，住院医师的舒适度与病例数量均呈现出正相关趋势（P值<0.001）。此外，更高水平的培训与舒适度的提高相关（P值=0.05）。感知到的培训需求与经验也相关（P值<0.001），这表明随着经验的增加，住院医师感觉他们的培训需求得到了满足。
我们的研究表明，住院医师能够根据实际经验和感知到的经验来评估自己的舒适度和培训需求。手术程序调查问卷已成为住院医师自我评估的有用工具，因为住院医师能够通过制定适当的学习计划在其教育中发挥更积极的作用。
