American Board of Surgery, Philadelphia, Pennsylvania.
J Surg Educ. 2013 Nov-Dec;70(6):783-8. doi: 10.1016/j.jsurg.2013.09.015. Epub 2013 Sep 26.
To evaluate trends in operative experience and to determine the effect of establishing the Surgical Council on Resident Education (SCORE) operative classification system on changes in operative volume among graduating surgery residents.
The general surgery operative logs of graduating surgery residents from 2005 were retrospectively compared with residents who completed training in 2010 and 2011. Nonparametric statistical analyses were used (Mann-Whitney and median test) with significance set at p<0.01.
A total of 1022 residents completing residency in 2005 were compared with 1923 residents completing training in 2010-2011.
Total operations reported increased from a median of 1023 to 1238 (21%) between 2005 and 2010-2011 (p<0.001). Cases increased in most SCORE categories. The median numbers of total, basic, and complex laparoscopic operations increased by 49%, 37%, and 82%, respectively, over the 5-year interval (p<0.001). Open cavitary (thoracic + abdominal) operations decreased by 5%, whereas other major operations increased by 35% (both p<0.001). The frequency of discrete operations done at least 10 times during residency did not change. The median number of SCORE essential-common operations performed ranged from 1 to 107, whereas essential-uncommon operations ranged from 0 to 4. Twenty-three of 67 SCORE essential-common operations (34%) had a median of less than 5 and 4 had a median of 0.
The operative volume of graduating surgical residents has increased by 21% since 2005; however, the number of operations done 10 times or greater has not changed. Although open cavitary procedures continue to decline, there has been a large increase in endoscopy, complex laparoscopic, and other major operations. Some essential-common operations continue to be performed infrequently. These results suggest that education in the operating room must improve and alternate methods for teaching infrequently performed procedures are needed.
评估手术经验的趋势，并确定建立住院医师教育外科委员会（SCORE）手术分类系统对毕业外科住院医师手术量变化的影响。
回顾性比较 2005 年毕业的外科住院医师的普通外科手术日志与 2010-2011 年完成培训的住院医师。使用非参数统计分析（Mann-Whitney 和中位数检验），显著性水平设为 p<0.01。
共有 1022 名 2005 年完成住院医师培训的住院医师与 1923 名 2010-2011 年完成培训的住院医师进行比较。
报告的总手术量从 2005 年的中位数 1023 例增加到 2010-2011 年的中位数 1238 例（增加 21%）（p<0.001）。大多数 SCORE 类别中的病例数均增加。5 年内，总手术、基础手术和复杂腹腔镜手术的中位数分别增加了 49%、37%和 82%（均 p<0.001）。开腹（胸腔+腹腔）手术减少了 5%，而其他主要手术增加了 35%（均 p<0.001）。住院期间至少进行 10 次的离散手术的频率没有变化。执行的 SCORE 基本常见手术的中位数数量范围为 1 至 107，而 SCORE 基本不常见手术的中位数数量范围为 0 至 4。在 67 项 SCORE 基本常见手术中，有 23 项（34%）的中位数少于 5，有 4 项的中位数为 0。
自 2005 年以来，毕业外科住院医师的手术量增加了 21%；然而，进行 10 次或更多次手术的数量并未改变。尽管开胸手术继续减少，但内镜、复杂腹腔镜和其他主要手术的数量却大幅增加。一些基本常见手术的操作仍然很少见。这些结果表明，手术室教育必须改进，需要寻找替代方法来教授不常见的手术。
