Tisherman Samuel A, Ivy Michael E, Frangos Spiros G, Kirton Orlando C
Department of Critical Care Medicine and Surgery, University of Pittsburgh, PA 15261, USA.
Arch Surg. 2011 Jan;146(1):101-6. doi: 10.1001/archsurg.2010.289.
The acute care surgery (ACS) 2-year training model, incorporating surgical critical care (SCC), trauma surgery, and emergency general surgery, was developed to improve resident interest in the field. We believed that analysis of survey responses about the new training paradigm before its implementation would yield valuable information on current practice patterns and on opinions about the ACS model.
Two surveys.
Members of the Surgery Section of the Society of Critical Care Medicine and SCC program directors.
One survey was sent to SCC program directors to define the practice patterns of trauma and SCC surgeons at their institutions, and another survey was sent to all Surgery Section of the Society of Critical Care Medicine members to solicit opinions about the ACS model.
Practice patterns of trauma and SCC surgeons and opinions about the ACS model.
Fifty-seven of 87 SCC program directors responded. Almost all programs are associated with level I trauma centers with as many as 15 trauma surgeons. Most of these trauma surgeons cover SCC and emergency general surgery. Sixty-six percent of surgical intensive care units are semiclosed; 89.0% have surgeons as directors. Seventy percent of the staff in surgical intensive care units are surgeons. One hundred fifty-five of approximately 1100 Surgery Section of the Society of Critical Care Medicine members who responded to the other survey did not believe that the ACS model would compromise surgical intensive care unit and trauma care or trainee education yet would allow surgeons to maintain their surgical skills. Respondents were less likely to believe that the ACS fellowship would be important financially, increase resident interest, or improve patient care.
In academic medical centers, surgical intensivists already practice the ACS model but depend on many nonsurgeons. Surgical intensivists believe that ACS will not compromise care or education and will help maintain the field, although the effect on resident interest is unclear.
急性护理外科（ACS）的两年培训模式，融合了外科重症监护（SCC）、创伤外科和急诊普通外科，旨在提高住院医师对该领域的兴趣。我们认为，在新培训模式实施前对调查反馈进行分析，将能获取有关当前实践模式以及对ACS模式看法的有价值信息。
两项调查。
危重病医学学会外科分会成员及SCC项目主任。
向SCC项目主任发送一项调查，以确定其所在机构创伤和SCC外科医生的实践模式；向危重病医学学会外科分会所有成员发送另一项调查，征求他们对ACS模式的意见。
创伤和SCC外科医生的实践模式以及对ACS模式的意见。
87名SCC项目主任中有57人回复。几乎所有项目都与一级创伤中心相关，有多达15名创伤外科医生。这些创伤外科医生大多同时负责SCC和急诊普通外科。66%的外科重症监护病房为半封闭式；89.0%由外科医生担任主任。外科重症监护病房70%的工作人员是外科医生。在回复另一项调查的约1100名危重病医学学会外科分会成员中，155人认为ACS模式不会损害外科重症监护病房和创伤护理或实习生教育，但能让外科医生保持其手术技能。受访者不太可能认为ACS专科培训在经济上很重要、会增加住院医师兴趣或改善患者护理。
在学术医疗中心，外科重症监护医生已在践行ACS模式，但依赖许多非外科医生。外科重症监护医生认为ACS不会损害护理或教育，并将有助于维持该领域，尽管对住院医师兴趣的影响尚不清楚。
