Fillmore W Jonathan, Teeples Tyson J, Cha Stephen, Viozzi Christopher F, Arce Kevin
Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Oral Maxillofac Surg. 2013 Feb;71(2):448-61. doi: 10.1016/j.joms.2012.05.006. Epub 2012 Aug 4.
To measure oral and maxillofacial surgery (OMS) chief resident case experience, including autonomy, and discover the role of this experience in developing resident confidence and determining the scope of practice on completion of training.
A cross-sectional study was conducted using an online questionnaire made available to residents near the completion of their final year of training in United States OMS training programs. Predictors were the case numbers and autonomy level. Outcomes were the anticipated frequency of practice, confidence to meet the standard of care, and changes in anticipated practice scope. Each was measured in 10 domains within the scope of OMS.
Eighty-four residents (44%) completed the 116-item questionnaire. All respondents were "very confident" in their ability to meet the standard of care in mandibular trauma and dentoalveolar surgery. Autonomy was associated with the confidence to meet the standard of care in midface trauma, temporomandibular joint, orthognathic, cosmetic, pathology, reconstructive, and craniofacial surgery. Associations were noted between primary surgeon cases and confidence in midface trauma, temporomandibular joint, orthognathic, cosmetic, and craniofacial surgery. Case numbers were associated with an anticipated frequency of practice within the domains of midface trauma, temporomandibular joint, cosmetic, and pathology surgery.
Results of this study suggest an association between a resident's surgical case experience (overall exposure and autonomy) and that resident's future plans for practice and confidence to meet the standard of care in this specialty. OMS training curricula should evolve to incorporate an evaluation of competence and an appropriate transfer of responsibility and experience to residents, thus maximizing confidence and future practice opportunities.
测量口腔颌面外科（OMS）住院总医师的病例经验，包括自主权，并探究该经验在培养住院医师信心以及确定培训结束后执业范围方面的作用。
采用横断面研究，通过在线问卷对即将完成美国OMS培训项目最后一年培训的住院医师进行调查。预测因素为病例数量和自主权水平。结果指标为预期的执业频率、达到医疗标准的信心以及预期执业范围的变化。每项指标均在OMS范围内的10个领域进行测量。
84名住院医师（44%）完成了这份包含116个条目的问卷。所有受访者对自己在下颌骨创伤和牙槽外科达到医疗标准的能力“非常有信心”。自主权与在面中部创伤、颞下颌关节、正颌、美容、病理、重建和颅面外科达到医疗标准的信心相关。主刀病例数与在面中部创伤、颞下颌关节、正颌、美容和颅面外科的信心之间存在关联。病例数量与面中部创伤、颞下颌关节、美容和病理外科领域预期的执业频率相关。
本研究结果表明，住院医师的手术病例经验（总体接触量和自主权）与该住院医师未来的执业计划以及在该专业达到医疗标准的信心之间存在关联。OMS培训课程应不断发展，纳入能力评估以及将责任和经验适当地传授给住院医师，从而最大限度地提高信心和未来的执业机会。
