Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 2 Dudley Street, Providence, RI 02905, USA.
J Bone Joint Surg Am. 2013 Aug 7;95(15):e108. doi: 10.2106/JBJS.L.00988.
Work-hour restrictions and increased supervision requirements have altered the clinical experience of orthopaedic surgery residents, while the specialty's body of knowledge and requisite skill set continue to expand. This dilemma means that the duration and practice experience of the traditional orthopaedic residency may not meet the needs of today's trainees. For the past eighteen years, however, residency training in the Department of Orthopaedic Surgery at Brown University has included a mandatory postgraduate year six (PGY6) trauma fellowship-modeled year, during which trainees are conferred full staff admitting and operating privileges, with time allotted for completing research. They are supervised by senior attending staff, with increasing autonomy as the year progresses. A formal, critical analysis of this transition-to-practice training model in orthopaedics has not previously been described.
An anonymous thirty-one-item questionnaire was distributed to all practicing graduates of the six-year Brown University Orthopaedic Surgery training program (n = 69). A 5-point Likert scale was used to assess attitudinal questions. An independent-sample t test was used to compare the responses of pre-duty-hour trainees with those of post-duty-hour trainees, with a p value of <0.05 utilized for significance.
All sixty-nine practicing graduates of the Brown University PGY6 trauma fellowship completed the survey (100% response rate). Most graduates (78.2%) would choose to complete the PGY6 year if they had to do residency again, and 72.4% would recommend trauma fellowship-modeled training to residents beginning their training. Trainees who completed residency during or after the imposed 2003 Accreditation Council for Graduate Medical Education duty-hour restrictions (79.3%) were significantly more likely (p = 0.014) to rank the PGY6 year as their most valuable training year compared with trainees who completed residency prior to duty-hour restrictions (50.0%). Nearly half of the graduates (46.4%) thought that the PGY6 fellowship year was financially burdensome.
The unique trauma fellowship-modeled sixth year of orthopaedic surgery training at Brown University was thought to be a valuable training experience by a large majority of graduates, although nearly half thought that the year was financially burdensome. These data suggest that a trauma fellowship-based sixth year of independent yet structured training has the potential to enhance orthopaedic education and could become an alternative standard given the current requirements imposed upon surgical residency training. These results may help guide further discussion among orthopaedic training programs to determine the optimal model for orthopaedic residency education in the twenty-first century.
工作时间限制和增加的监督要求改变了骨科住院医师的临床经验，而该专业的知识体系和必要技能仍在不断扩大。这一困境意味着传统骨科住院医师的时间和实践经验可能无法满足今天学员的需求。然而，在过去的十八年中，布朗大学骨科的住院医师培训包括了一个强制性的第六年住院医师（PGY6）创伤研究员模式年，在此期间，学员被授予全面的主治医生收治和手术权限，并分配时间完成研究。他们由资深主治医生监督，随着时间的推移，他们的自主权逐渐增加。在骨科中，这种向实践培训模式的转变尚未进行过正式、批判性的分析。
向布朗大学六年骨科住院医师培训项目的所有 69 名毕业生（n=69）发放了一份匿名的 31 项问卷。使用 5 分李克特量表评估态度问题。使用独立样本 t 检验比较了工作时间前的学员和工作时间后的学员的反应，显著性水平设为 p < 0.05。
布朗大学 PGY6 创伤研究员的所有 69 名毕业生都完成了调查（100%的回应率）。大多数毕业生（78.2%）表示如果要再次进行住院医师培训，他们会选择完成 PGY6 年，而 72.4%的人会向开始培训的住院医师推荐创伤研究员模式的培训。在 2003 年研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education）工作时间限制实施期间或之后完成住院医师培训的学员（79.3%），明显更有可能（p=0.014）将 PGY6 年评为他们最有价值的培训年，而在工作时间限制之前完成住院医师培训的学员（50.0%）。将近一半的毕业生（46.4%）认为 PGY6 研究员年的经济负担沉重。
布朗大学独特的创伤研究员模式第六年骨科住院医师培训被大多数毕业生认为是一种有价值的培训经验，尽管近一半的人认为这一年的经济负担沉重。这些数据表明，基于创伤研究员的第六年独立但结构化的培训有可能增强骨科教育，并可能成为当前对外科住院医师培训施加的要求的替代标准。这些结果可能有助于指导骨科培训项目之间的进一步讨论，以确定二十一世纪骨科住院医师教育的最佳模式。
