Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA.
J Trauma Acute Care Surg. 2012 Dec;73(6):1500-6. doi: 10.1097/TA.0b013e318270d983.
Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line.
The Accreditation Council for Graduate Medical Education (ACGME) database of operative logs was queried from academic year (AY) 1989-1990 to 2009-2010 to identify shifts in trauma operative experience. Annual case log data for each cohort of graduating surgery residents were combined into approximately 5-year blocks, designated Period I (AY1989-1990 to AY1993-1994), Period II (AY1994-1995 to AY1998-1999), Period III (AY1999-2000 to AY2002-2003), and Period IV (AY2003-2004 to AY2009-2010). The latter two periods were delineated by the year in which duty hour restrictions were implemented.
Overall general surgery caseload increased from Period I to Period II (p < 0.001), remained stable from Period II to Period III, and decreased from Period III to Period IV (p < 0.001). However, for ACGME-designated trauma cases, there were significant declines from Period I to Period II (75.5 vs. 54.5 cases, p < 0.001) and Period II to Period III (54.5 vs. 39.3 cases, p < 0.001) but no difference between Period III and Period IV (39.3 vs. 39.4 cases). Graduating residents in Period I performed, on average, 31 intra-abdominal trauma operations, including approximately five spleen and four liver operations. Residents in Period IV performed 17 intra-abdominal trauma operations, including three spleen and approximately two liver operations.
Recent general surgery trainees perform fewer trauma operations than previous trainees. The majority of this decline occurred before implementation of work-hour restrictions. Although these changes reflect concurrent changes in management of trauma, surgical educators must meet the challenge of training residents in procedures less frequently performed.
Epidemiologic study, level III; therapeutic study, level IV.
外科住院医师的教育基于经验培训，而经验培训受临床管理策略变化、技术和技术进步以及行政规定的影响。创伤治疗受到了这些因素的影响，这引发了人们对住院医师手术创伤经验的关注。本研究分析了过去二十年中报告的手术创伤量；据我们所知，这是首次对如此长时间段内的全国趋势进行评估。
从学术年（AY）1989-1990 年到 2009-2010 年，查询研究生医学教育认证委员会（ACGME）手术记录数据库，以确定创伤手术经验的变化。将每批毕业外科住院医师的年度病历数据合并成大约 5 年的块，分别标记为第 I 期（AY1989-1990 至 AY1993-1994）、第 II 期（AY1994-1995 至 AY1998-1999）、第 III 期（AY1999-2000 至 AY2002-2003）和第 IV 期（AY2003-2004 至 AY2009-2010）。后两个时期是由实施工作时间限制的年份划定的。
总体普外科手术量从第 I 期增加到第 II 期（p < 0.001），从第 II 期到第 III 期保持稳定，从第 III 期到第 IV 期减少（p < 0.001）。然而，对于 ACGME 指定的创伤病例，从第 I 期到第 II 期（75.5 与 54.5 例，p < 0.001）和第 II 期到第 III 期（54.5 与 39.3 例，p < 0.001）都有显著下降，但第 III 期和第 IV 期之间没有差异（39.3 与 39.4 例）。第 I 期的毕业住院医师平均进行了 31 例腹部创伤手术，包括大约 5 例脾切除术和 4 例肝切除术。第 IV 期的住院医师进行了 17 例腹部创伤手术，包括 3 例脾切除术和约 2 例肝切除术。
最近的普通外科住院医师进行的创伤手术比以前的住院医师少。这种下降的大部分发生在工作时间限制实施之前。尽管这些变化反映了创伤治疗的管理变化，但外科教育者必须应对培训住院医师进行较少执行手术的挑战。
流行病学研究，III 级；治疗性研究，IV 级。
