Department of Systems Engineering, University Hospital, Augusta, GA 30909, USA.
Health Care Manag Sci. 2013 Sep;16(3):217-27. doi: 10.1007/s10729-013-9230-6. Epub 2013 Mar 22.
The primary goal of a residency program is to prepare trainees for unsupervised care. Duty hour restrictions imposed throughout the prior decade require that residents work significantly fewer hours. Moreover, various stakeholders (e.g. the hospital, mentors, other residents, educators, and patients) require them to prioritize very different activities, often conflicting with their learning goals. Surgical residents' learning goals include providing continuity throughout a patient's pre-, peri-, and post-operative care as well as achieving sufficient surgical experience levels in various procedure types and participating in various formal educational activities, among other things. To complicate matters, senior residents often compete with other residents for surgical experience. This paper features experiments using an optimization model and a real dataset. The experiments test the viability of achieving the above goals at a major academic center using existing models of delivering medical education and training to surgical residents. It develops a detailed multi-objective, two-stage stochastic optimization model with anticipatory capabilities solved over a rolling time horizon. A novel feature of the models is the incorporation of learning curve theory in the objection function. Using a deterministic version of the model, we identify bounds on the achievement of learning goals under existing training paradigms. The computational results highlight the structural problems in the current surgical resident educational system. These results further corroborate earlier findings and suggest an educational system redesign is necessary for surgical medical residents.
住院医师规范化培训项目的主要目标是为培训对象提供独立行医的能力。过去十年间实施的工时限制要求住院医师的工作时间显著减少。此外，各种利益相关者（如医院、导师、其他住院医师、教育工作者和患者）要求他们优先考虑非常不同的活动，这些活动往往与他们的学习目标相冲突。外科住院医师的学习目标包括为患者的术前、术中和术后护理提供连续性，以及在各种手术类型中获得足够的手术经验水平，并参与各种正式的教育活动等。更复杂的是，高年资住院医师经常与其他住院医师争夺手术经验。本文采用优化模型和真实数据集进行实验。这些实验测试了在主要学术中心使用现有的医学教育和培训模式来实现上述目标的可行性。它开发了一个具有前瞻性的详细的多目标、两阶段随机优化模型，并在滚动时间范围内进行求解。模型的一个新颖特征是在目标函数中纳入了学习曲线理论。通过使用模型的确定性版本，我们确定了在现有的培训模式下实现学习目标的界限。计算结果突出了当前外科住院医师教育系统中的结构问题。这些结果进一步证实了早期的发现，并表明需要对外科住院医师的教育系统进行重新设计。
