Wigton R S, Blank L L, Monsour H, Nicolas J A
University of Nebraska College of Medicine, Omaha.
Ann Intern Med. 1990 Oct 1;113(7):540-6. doi: 10.7326/0003-4819-113-7-540.
To find which procedures gastroenterologists do in their practice, where they learned the procedures, and what training they recommend to achieve and maintain competence in each.
Mailed survey.
A random sample of 700 gastroenterologists who were members of the American College of Physicians, of whom 510 (73%) responded.
Gastroenterologists did a median of 27 of the 40 gastroenterology procedures and 3 of the 16 general medicine procedures. A larger number of different procedures was done by those who were board certified in gastroenterology, spent more than 60 hours per week in patient care, graduated after 1969, or practiced in a university setting, a hospital with 250 to 500 beds, or a group limited to gastroenterologists. The majority of respondents had done each of the three most commonly done procedures 200 or more times in the previous year. For 10 procedures studied in detail, the majority had done 9 of the 10 in the past year at least as often as the median recommendation for maintaining competence. The number of procedures recommended to achieve and maintain competence differed little by the age, type of practice, and gastroenterology board certification status of the respondent. For most procedures, the range of recommendations was broad, but the median numbers agreed with other published recommendations. Respondents learned 31% of procedures after they had completed training. The earlier their training, the more likely they had learned the procedure in practice.
Gastroenterologists do many different procedures, and this number is influenced by how recently they were trained and the nature of their practice. Respondents learned nearly one third of the procedures they do after they had completed training. It is an important and continuing challenge for the profession to assure that physicians learn and maintain these procedural skills at the highest level of proficiency.
了解胃肠病学家在临床实践中开展哪些操作，他们是在哪里学习这些操作的，以及他们建议进行何种培训以获得并保持各项操作的能力。
邮寄调查问卷。
从美国医师学会的700名胃肠病学家中随机抽取样本，其中510人（73%）回复了问卷。
胃肠病学家在40项胃肠病学操作中，中位数为27项；在16项普通内科操作中，中位数为3项。获得胃肠病学委员会认证、每周花费超过60小时进行患者护理、1969年后毕业或在大学环境、拥有250至500张床位的医院或仅由胃肠病学家组成的团体中执业的人，开展的不同操作数量更多。大多数受访者在前一年中，三项最常进行的操作每项都做了200次或更多。对于详细研究的10项操作，大多数人在过去一年中进行了其中9项，至少与维持能力的中位数建议频率相同。对于获得并保持能力的建议操作数量，受访者的年龄、执业类型和胃肠病学委员会认证状态影响不大。对于大多数操作，建议范围较广，但中位数与其他已发表的建议一致。受访者在完成培训后学习了31%的操作。他们接受培训的时间越早，就越有可能在实践中学习该操作。
胃肠病学家开展多种不同的操作，这一数量受他们最近接受培训的时间和执业性质的影响。受访者在完成培训后学习了近三分之一的操作。确保医生以最高水平的熟练程度学习并保持这些操作技能，对该行业来说是一项重要且持续的挑战。
