Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
Surgery. 2011 Apr;149(4):465-73. doi: 10.1016/j.surg.2010.11.007. Epub 2011 Feb 5.
Two important changes in the past decade have altered the landscape of graduate medical education (GME) in the U.S. The national restrictions on trainee duty hours mandated by the Accreditation Council for Graduate Medical Education (ACGME) were the most visible and generated much controversy. Equally important is the ACGME Outcome Project, which mandates competency-based training. Both of these changes have unique implications for surgery trainees, who traditionally spent long hours caring for patients in the hospital, and who must be assessed in 2 broad domains: their medical care of pre- and postoperative patients, and their technical skill with procedures in and out of the operating room. This article summarizes 3 key challenges that lie ahead for surgical educators. First, the changes in duty hours in the past 7 years are summarized, and the conversation about added restrictions planned for July 2011 is reviewed. Next, the current state of the assessment of competency among surgical trainees is reviewed, with an outline of the challenges that need to be overcome to achieve widespread, competency-based training in surgery. Finally, the article summarizes the problems caused by increased reliance on handoffs among trainees as they compensate for decreased time in the hospital, and suggests changes that need to be made to improve safety and efficiency, including how to use handoffs as part of our educational evaluation of residents.
在过去的十年中，美国的研究生医学教育（GME）发生了两个重要变化。美国研究生医学教育认证委员会（ACGME）规定的对住院医师工作时间的国家限制是最明显的，也引发了很多争议。同样重要的是 ACGME 结果项目，该项目要求基于能力的培训。这两个变化都对传统上在医院照顾病人的时间很长的外科住院医师有独特的影响，他们必须在两个广泛的领域进行评估：他们对术前和术后患者的医疗护理，以及他们在手术室内外进行手术的技术技能。本文总结了外科教育者面临的 3 个关键挑战。首先，总结了过去 7 年中工作时间的变化，并回顾了计划于 2011 年 7 月实施的额外限制的讨论。接下来，审查了外科住院医师能力评估的现状，并概述了在外科中实现广泛的基于能力的培训所需克服的挑战。最后，本文总结了由于住院医师在医院工作时间减少而增加轮班所导致的问题，并提出了需要做出的改变，以提高安全性和效率，包括如何将轮班作为住院医师教育评估的一部分。
