Fairfax Lindsay M, Christmas A Britton, Green John M, Miles William S, Sing Ronald F
Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
Am Surg. 2010 Jun;76(6):578-82.
Since the institution of Accreditation Council for Graduate Medical Education (ACGME) resident work hour restrictions, conflicting evidence exists regarding the impact on resident case volume with most data from single-institution studies. We examined the effect of restrictions on national resident operative experience. After permission from the ACGME, we reviewed the publicly available national resident case log data (1999 through 2008) maintained on the ACGME web site (www.acgme.org), including total major cases with subanalysis of the ACGME-specified categories. The mean cases per resident were compared before (1999 to 2003) and after (2003 to 2008) restrictions. After the implementation of duty hour restrictions, the mean number of total cases per resident significantly decreased (949 +/- 18 vs 911 +/- 14, P = 0.004). Subanalysis showed a significant increase in alimentary tract (217 +/- 7 vs 229 +/- 3, P = 0.004), skin/soft tissue (31 +/- 3 vs 36 +/- 1, P = 0.01), and endocrine (26 +/- 2 vs 31 +/- 2, P = 0.006) cases. However, we observed a significant decrease in head and neck (21 +/- 0.3 vs 20 +/- 0.3, P = 0.01), vascular (164 +/- 29 vs 126 +/- 5, P = 0.01), pediatric (41 +/- 1 vs 37 +/- 2, P = 0.006), genitourinary (10 +/- 2 vs 7 +/- 1, P = 0.004), gynecologic surgery (5 +/- 1 vs 3 +/- 0.6, P = 0.002), plastics (16 +/- 0.3 vs 15 +/- 0.7, P = 0.03), and endoscopy (91 +/- 3 vs 82 +/- 2, P < 0.001) procedures. Analysis of the ACGME-compiled national data confirms that duty hour restrictions have significantly impacted resident operative experience. Importantly, experience in specialty areas, including vascular and endoscopy, appears to have been sacrificed for consolidation of resources into general surgery services as indicated by the increase in alimentary tract and endocrine cases. These findings raise the following question: Is the era of truly broad-based general surgery training coming to an end?
自从研究生医学教育认证委员会（ACGME）对住院医师工作时长进行限制以来，关于这一限制对住院医师病例量的影响存在相互矛盾的证据，且大多数数据来自单机构研究。我们研究了这些限制对全国住院医师手术经验的影响。经ACGME许可，我们查阅了ACGME网站（www.acgme.org）上公开的全国住院医师病例日志数据（1999年至2008年），包括主要病例总数，并对ACGME指定的类别进行了亚分析。比较了限制实施前（1999年至2003年）和实施后（2003年至2008年）每位住院医师的平均病例数。实施工作时长限制后，每位住院医师的总病例数显著减少（949±18对911±14，P = 0.004）。亚分析显示，消化道（217±7对229±3，P = 0.004）、皮肤/软组织（31±3对36±1，P = 0.01）和内分泌（26±2对31±2，P = 0.006）病例显著增加。然而，我们观察到头颈部（21±0.3对20±0.3，P = 0.01）、血管（164±29对126±5，P = 0.01）、儿科（41±1对37±2，P = 0.006）、泌尿生殖系统（10±2对7±1，P = 0.004）、妇科手术（5±1对3±0.6，P = 0.002）、整形（16±0.3对15±0.7，P = 0.03）和内镜检查（91±3对82±2，P < 0.001）手术显著减少。对ACGME汇编的全国数据的分析证实，工作时长限制对住院医师的手术经验产生了重大影响。重要的是，正如消化道和内分泌病例的增加所表明的，为了将资源整合到普通外科服务中，包括血管和内镜检查在内的专科领域的经验似乎被牺牲了。这些发现提出了以下问题：真正基础广泛的普通外科培训时代即将结束吗？
Zotero 插件