Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Surg Educ. 2012 Sep-Oct;69(5):643-9. doi: 10.1016/j.jsurg.2012.06.007. Epub 2012 Jul 15.
With the institution of the work-hour restrictions in 2003, less time may be available for surgical residents to learn operative technique and judgment. While numerous studies have evaluated the use of surgical simulation training to enhance operative skills, little is known about the quality of teaching that takes place in the operating room (OR). The purpose of this study was to assess residents' perception of faculty teaching in the OR in order to target ways to improve operative education.
A request for resident participation in an online survey was sent to the Program Coordinator at all 255 ACGME-accredited general surgery residency programs.
A total of 148 programs (59%) participated in the survey, and anonymous responses were submitted by 998 of 4926 residents (20%). Most residents reported that attending surgeons verbalize their operative approach (55%), include residents in intraoperative decisions (61%), and offer technical advice (84%). However, few residents reported that faculty help to identify the resident's personal educational operative goals preoperatively (18%) or discuss areas of improvement with residents (37%). Of all cases scrubbed in the past year, most residents feel as though they only actually performed the procedure between 26% and 50% (29%) or between 51% and 75% (32%) of the time. However, more than half of all residents (51%) log these procedures for ACGME as primary surgeon 76%-100% of the time.
This study demonstrates that from the residents' perspective, a number of opportunities exist to improve teaching in the OR, such as guiding residents with preoperative preparation and providing them with constructive feedback. These findings also suggest that residents may be logging cases without feeling as though they actually perform the operations.
2003 年实施工作时间限制后，外科住院医师用于学习手术技术和判断的时间可能会减少。虽然许多研究评估了使用手术模拟训练来提高手术技能，但对于手术室（OR）中教学质量知之甚少。本研究旨在评估住院医师对 OR 中教师教学的看法，以便确定改进手术教育的方法。
向所有 255 个 ACGME 认证的普通外科住院医师培训计划的项目协调员发送了一份在线调查居民参与的请求。
共有 148 个计划（59%）参与了调查，4926 名住院医师中有 998 名（20%）匿名提交了回复。大多数住院医师报告说，主治外科医生会口头说明他们的手术方法（55%），将住院医师纳入手术中的决策（61%）并提供技术建议（84%）。然而，很少有住院医师报告说教师会帮助确定住院医师术前的个人教育手术目标（18%）或与住院医师讨论改进的领域（37%）。在过去一年中参与过的所有手术中，大多数住院医师认为他们实际上只在 26%至 50%（29%）或 51%至 75%（32%）的时间内进行手术。然而，超过一半的住院医师（51%）会将这些程序记录为 ACGME 的主要外科医生，时间为 76%-100%。
这项研究表明，从住院医师的角度来看，有许多机会可以改善 OR 中的教学，例如指导住院医师进行术前准备并为他们提供建设性的反馈。这些发现还表明，住院医师可能在记录病例时并没有觉得自己实际上进行了手术。
