Department of General Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
J Surg Educ. 2011 Jan-Feb;68(1):44-51. doi: 10.1016/j.jsurg.2010.08.004. Epub 2010 Nov 5.
Craft specialties, such as surgery, rely on practice to acquire skill. Yet recent changes in training in the United Kingdom have decreased experience and altered the balance of curriculum content. Most recently, the European Working Time Directive has led to a reduction in working hours and expansion in the number of trainees. The impact that these changes have had on operative experience, patient management, communication, and teaching skills is unclear. This study aims to assess the effects of the changing curriculum and work patterns on the experience of trainees at senior house officer (SHO, equivalent to junior resident) level in general surgery.
A structured questionnaire was sent to general surgery trainees at the SHO (n = 52) and specialist registrar (SpR, n = 69) levels (equivalent to senior resident) in the Severn Deanery, United Kingdom.
In all, 70% of both SHOs and SpRs responded. SpRs had spent a mean of 50 months (21 months in general surgery) at the SHO level, compared with 24 months (9 months in general surgery) for current SHOs. A total of 90% of SpRs could perform an open appendectomy unsupervised by the end of their SHO training, compared with 28% of current SHOs. In all, 63% of SpRs and 8% of SHOs could undertake inguinal hernia repair unsupervised at SHO level. In addition, 90% of SpRs and 84% of SHOs felt operative skills have declined, whereas communication and teaching skills were deemed the same or better. Of the respondents, 88% of SpRs and 76% of SHOs thought surgical training was getting worse.
Trainees are spending less time in surgery at the SHO level, and this is reflected in reported operative ability. The introduction of communication and teaching skills into the curriculum has had a perceived benefit. The reduction in working hours must be offset by implementing measures to maximize limited training opportunities. The potential implications of these changes in training and experience on patient outcomes remain to be determined.
像外科这样的专业依赖于实践来获得技能。然而，英国培训方面的最新变化减少了经验并改变了课程内容的平衡。最近，欧洲工作时间指令导致工作时间减少和受训人数增加。这些变化对手术经验、患者管理、沟通和教学技能的影响尚不清楚。本研究旨在评估不断变化的课程和工作模式对普通外科住院医师（SHO，相当于初级住院医师）级别受训者经验的影响。
向英国塞文教务区的普通外科住院医师（SHO，n=52）和专科住院医师（SpR，n=69）（相当于高级住院医师）发送了一份结构化问卷。
共有 70%的 SHO 和 SpR 做出了回应。SpR 在 SHO 级别上平均花费了 50 个月（21 个月在普通外科），而目前的 SHO 则花费了 24 个月（9 个月在普通外科）。在 SHO 培训结束时，90%的 SpR 可以独立进行开放性阑尾切除术，而目前的 SHO 中只有 28%可以做到。在所有情况下，63%的 SpR 和 8%的 SHO 可以在 SHO 级别上独立进行腹股沟疝修补术。此外，90%的 SpR 和 84%的 SHO 认为手术技能有所下降，而沟通和教学技能被认为相同或更好。在受访者中，88%的 SpR 和 76%的 SHO 认为外科培训正在恶化。
住院医师在 SHO 级别上接受的外科手术时间减少，这反映在报告的手术能力中。将沟通和教学技能引入课程被认为具有积极意义。工作时间的减少必须通过实施措施来最大限度地增加有限的培训机会来抵消。这些培训和经验变化对患者结果的潜在影响仍有待确定。
