量与质：急症外科手术病案日志第一年分析。
How much and what type: analysis of the first year of the acute care surgery operative case log.
机构信息
From the Department of Surgery (C.J.D.), Emory University, Atlanta, Georgia; Department of Surgery (T.M.D.), VCU Medical Center, Richmond, Virginia; Department of Surgery (G.J.J.), Denver Health Medical Center, Denver, Colorado; Department of Surgery (L.D.B.), Eastern Virginia Medical School, Norfolk, Virginia; Department of Surgery (J.W.M.), Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and Department of Surgery (J.J.F.), University of Nevada School of Medicine, Las Vegas, Nevada.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):329-38; discussion 338-9. doi: 10.1097/TA.0000000000000114.
BACKGROUND
A case log was created by the American Association for the Surgery of Trauma Acute Care Surgery (ACS) committee to track trainee operative experiences, allowing them to enter their cases in the form of Current Procedural Terminology (CPT) codes. We hypothesized that the number of cases an ACS trainee performed would be similar to the expectations of a fifth-year general surgery resident and that the current list of essential and desired cases (E/D list) would accurately reflect cases done by ACS trainees.
METHODS
The database was queried from July 1, 2011, to June 30, 2012. Trainees were classified as those in American Association for the Surgery of Trauma-accredited fellowships (ACC) and those in ACS fellowships not accredited (non-ACC). CPT codes were mapped to the E/D list. Cases entered manually were individually reviewed and assigned a CPT code if possible or listed as "noncodable." To compensate for nonoperative rotations and noncompliance, case numbers were analyzed both annually and monthly to estimate average case numbers for all trainees. In addition, case logs of trainees were compared with the E/D list to assess how well it reflected actual trainee experience.
RESULTS
Eighteen ACC ACS and 11 non-ACC ACS trainees performed 16.4 (12.6) cases per month compared with 15.7 (14.2) cases for non-ACC ACS fellows (p = 0.71). When annualized, trainees performed, on average, 195 cases per year. Annual analysis led to similar results. The E/D list captured only approximately 50% of the trainees' operative experience. Only 77 cases were categorized as pediatric.
CONCLUSION
ACS trainees have substantial operative experience averaging nearly 200 major cases during their ACS year. However, high variability exists in the number of essential or desirable cases being performed with approximately 50% of the fellows' operative experience falling outside the E/D list of cases. Modification of the fellows' operative experience and/or the rotation requirements seems to be needed to provide experience in E/D cases.
背景
美国创伤外科学会（ACS）急性护理外科委员会创建了病例记录，以跟踪学员的手术经验，允许他们以当前操作术语（CPT）代码的形式输入他们的病例。我们假设 ACS 学员完成的病例数量与第五年普通外科住院医师的预期相似，并且当前的基本和期望病例（E/D 列表）将准确反映 ACS 学员完成的病例。
方法
从 2011 年 7 月 1 日至 2012 年 6 月 30 日，对数据库进行了查询。将学员分为 ACS 认可的住院医师培训（ACC）和 ACS 非认可（非 ACC）住院医师培训。CPT 代码被映射到 E/D 列表。手动输入的病例被单独审查，如果可能的话，会分配一个 CPT 代码，否则将其列为“不可编码”。为了补偿非手术轮转和不遵守规定，对病例数量进行了年度和月度分析，以估算所有学员的平均病例数量。此外，还将学员的病例记录与 E/D 列表进行了比较，以评估其反映实际学员经验的程度。
结果
18 名 ACC ACS 和 11 名非 ACC ACS 学员每月完成 16.4（12.6）例手术，而非 ACC ACS 学员为 15.7（14.2）例（p=0.71）。按年度计算，学员平均每年完成 195 例。年度分析得出了类似的结果。E/D 列表仅捕获了学员手术经验的约 50%。只有 77 例被归类为儿科。
结论
ACS 学员的手术经验非常丰富，平均在 ACS 年度完成近 200 例大手术。然而，完成的基本或期望病例数量存在很大差异，大约 50%的学员手术经验不在 E/D 列表范围内。似乎需要修改学员的手术经验和/或轮转要求，以提供 E/D 病例的经验。
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