Department of Surgery, Christ Community Health Services, Memphis, Tennessee 38104, USA.
J Surg Educ. 2012 May-Jun;69(3):311-9. doi: 10.1016/j.jsurg.2011.10.009. Epub 2011 Dec 19.
Interest in international surgery among general surgery residents in the United States has been shown in several publications. Several general surgery residency programs have reported their experiences with international surgery rotations (ISRs). Learning to use limited resources more efficiently is often cited as a benefit of such rotations. We hypothesized that general surgery residents become more resource efficient after they have completed an ISR.
Laboratory, radiologic, and diagnostic studies ordered on 2900 patients by 21 general surgery residents over 65 months at a single institution were analyzed retrospectively. The patient populations they wrote orders on were assessed for similarity in age, gender, and diagnoses. The outcomes in those patient populations were assessed by duration of stay and in-hospital mortality. Six (29%) of these residents (ISR residents) completed a 1-month ISR during their third year of residency. Their orders were compared with their classmates who did not participate in an ISR (NISR residents). The results were compared between the 2 cohorts from both before and after their international rotations. An analysis focused on comparing the changes from pre-ISR to post-ISR. A survey was also sent after objective data were collected to all residents and alumni involved in the study to assess their subjective perception of changes in their resource efficiency and to characterize their ISRs.
Patient populations were similar in terms of demographics and diagnoses. ISR residents generated an average of $122 less in orders per patient per month after their ISR compared with before. NISR residents generated an average of $338 more in orders per patient per month after the ISRs compared with before (p = 0.04). Pre-ISR order charges were statistically similar. Similar results were observed when radiologic/diagnostic study orders were analyzed independently. Differences in outcomes were statistically insignificant. The survey revealed that most of the ISR residents perceived that their attitude toward ordering tests and laboratories was influenced greatly by their ISR, and all the ISR residents perceived that they became more resource efficient than their peers after their ISRs.
These preliminary findings seem to indicate increased resource efficiency among general surgery residents who completed an ISR. However, the sample size of residents was small, and we could not establish conclusively a causal relationship to their ISRs. A more extensive study is needed if reliable conclusions are to be drawn regarding the effect of ISRs on the resource efficiency of residents.
几项出版物已经表明，美国普通外科住院医师对国际外科手术感兴趣。一些普通外科住院医师培训计划已经报告了他们在国际外科轮转（ISR）方面的经验。人们常说，学习更有效地利用有限的资源是此类轮转的好处之一。我们假设普通外科住院医师在完成 ISR 后会变得更有效率。
在一家机构的 65 个月内，对 21 名普通外科住院医师为 2900 名患者进行的实验室、放射学和诊断研究进行了回顾性分析。他们为患者群体开的订单在年龄、性别和诊断方面进行了评估。通过住院时间和院内死亡率来评估这些患者群体的结果。这 21 名住院医师中有 6 名（29%）在住院医师培训的第三年完成了为期 1 个月的 ISR。将他们的订单与未参加 ISR 的同学（NISR 居民）的订单进行了比较。从国际轮转前后，对两组数据进行了比较。分析重点是比较 ISR 前后的变化。在收集客观数据后，还向所有参与研究的住院医师和校友发送了一份调查，以评估他们对资源效率变化的主观认识，并描述他们的 ISR。
患者群体在人口统计学和诊断方面相似。ISR 住院医师在 ISR 后平均每个患者每月的订单费用减少了 122 美元，而 NISR 住院医师在 ISR 后平均每个患者每月的订单费用增加了 338 美元（p=0.04）。ISR 前的订单费用统计上相似。当独立分析放射学/诊断研究订单时，也观察到类似的结果。结果差异无统计学意义。调查显示，大多数 ISR 住院医师认为他们的检查和实验室订单态度受到 ISR 的极大影响，所有 ISR 住院医师都认为他们在 ISR 后比同龄人更有效率。
这些初步发现似乎表明，完成 ISR 的普通外科住院医师的资源效率有所提高。然而，住院医师的样本量很小，我们不能确定他们的 ISR 与资源效率之间有因果关系。如果要得出关于 ISR 对住院医师资源效率影响的可靠结论，还需要进行更广泛的研究。
