美国外科医师学院/外科住院医师培训项目主任协会外科住院医师技能课程采用的障碍。

Barriers to adoption of the surgical resident skills curriculum of the American College of Surgeons/Association of Program Directors in Surgery.

机构信息

Surgical Learning Center, William Beaumont Hospital, Royal Oak, MI 48073, USA.

出版信息

Surgery. 2013 Jul;154(1):23-8. doi: 10.1016/j.surg.2013.04.058.

DOI:10.1016/j.surg.2013.04.058

PMID:23809481

Abstract

BACKGROUND

The American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) jointly developed a standardized skills curriculum for surgical residents. This program was intended to be affordable, reproducible, reliable, and proficiency-based. Some experts have proposed mandating that all residency programs implement the curriculum. Although general surgery program directors have supported uniformly the use of simulation in training, one third of general surgery residencies have no simulation curricula. Our goal was to identify barriers to the implementation of the ACS/APDS curriculum.

METHODS

The ACS/APDS skills curriculum was analyzed on the basis of the ACS website. All materials listed in each module in all 3 phases were tabulated. Supply costs per resident were calculated along with the time requirements for each.

RESULTS

The approximate cost per resident for supplies to complete the entire ACS/APDS skills curriculum exceeds $30,000. The initial cost for the development of our surgery learning center was $4.5 million. Capital equipment and instruments were an additional cost. Time to complete the program was 90 h for each resident, with additional time commitments by surgery faculty, simulation center staff, educational development staff, and veterinary staff. Simulation staffing costs were $22,107.

CONCLUSION

The ACS/APDS skills curriculum has a substantial resource commitment associated with its implementation. These capital, instrument, and personnel costs present a major challenge to residency programs that want to adopt this program. Faculty participation in the program poses an additional logistic challenge. Last, resident involvement must be scheduled within the 80-h work-week limit, impacting resident availability for their obligations of patient care. Re-examination of the scope and complexity appears warranted, along with development of low-fidelity substitutions for the proposed modules as well as opportunities for resource-sharing.

摘要

背景

美国外科医师学院（ACS）和外科医师培训计划协会（APDS）联合为外科住院医师制定了标准化技能课程。该计划旨在具有成本效益、可重复、可靠和以熟练度为基础。一些专家建议要求所有住院医师培训计划实施该课程。尽管普通外科项目主任普遍支持在培训中使用模拟，但三分之一的普通外科住院医师没有模拟课程。我们的目标是确定实施 ACS/APDS 课程的障碍。

方法

根据 ACS 网站对 ACS/APDS 技能课程进行了分析。对所有 3 个阶段的每个模块中的所有列出的材料进行了制表。计算了每位居民的供应成本，并计算了每个模块的时间要求。

结果

完成 ACS/APDS 技能课程所需的每位居民的用品费用估计超过 30000 美元。我们手术学习中心的初始开发成本为 450 万美元。资本设备和仪器是额外的成本。每位居民完成该计划的时间为 90 小时，外科教员、模拟中心工作人员、教育发展人员和兽医人员还需要额外的时间投入。模拟人员的费用为 22107 美元。

结论

ACS/APDS 技能课程的实施需要大量资源投入。这些资本、仪器和人员成本对希望采用该计划的住院医师培训计划构成了重大挑战。教员参与该计划还带来了额外的后勤挑战。最后，居民参与必须在 80 小时工作周的限制内安排，这会影响居民为患者护理义务提供的可用性。重新审查范围和复杂性似乎是合理的，同时还需要为拟议模块开发低保真替代品以及资源共享机会。