Komiya Kiyoshi, Saito Momoko, Sakurai Yuika, Kojima Hiromi, Takase Kozo
Section of Research Development, Department of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University.
J Med Dent Sci. 2014 Jan 17;60(4):93-101.
During the past 10 years, residency training in otorhinolaryngology-head and neck surgery (ORL-HNS) in Japan, especially at university hospitals, has emphasized subspecialization, resulting in insufficiencies in basic surgical techniques with an extreme bias toward acquiring subspecialty surgical case experience. To address this problem, we developed a target-oriented program intended to achieve a more balanced approach to surgical training and performed a 1-year trial of the program at the Jikei University School of Medicine. Fourteen residents with 1 to 4 years of ORL-HNS experience completed the trial. Each resident's competencies in six basic surgical procedures were assessed on the basis of the number of cases handled by the resident, and each resident's case selection bias after implementation of the target-oriented training was examined. The case selection bias in the trial group residents was reduced and their balance in case experience was shown to be improved in comparison with that in control group residents who were trained in the conventional way. In addition, opinion surveys of the participants and supervising otorhinolaryngologists (trainers) indicated that they felt that the new training system had been effective in improving the balance in case experience and improving motivation, and creating greater awareness of training goals and progress.
在过去10年里，日本耳鼻咽喉头颈外科（ORL-HNS）的住院医师培训，尤其是在大学医院，一直强调亚专业培训，导致基础外科技术不足，过度偏向获取亚专业手术病例经验。为解决这一问题，我们制定了一个以目标为导向的项目，旨在实现更平衡的外科培训方法，并在东京慈惠会医科大学对该项目进行了为期1年的试验。14名有1至4年ORL-HNS经验的住院医师完成了该试验。根据住院医师处理的病例数量评估每位住院医师在六种基本外科手术中的能力，并检查了实施目标导向培训后每位住院医师的病例选择偏向。与接受传统培训的对照组住院医师相比，试验组住院医师的病例选择偏向有所减少，病例经验的平衡性也有所提高。此外，对参与者和指导耳鼻咽喉科医生（培训师）的意见调查表明，他们认为新的培训系统有效地改善了病例经验的平衡性，提高了积极性，并增强了对培训目标和进展的认识。
