Torsney K M, Cocker D M, Slesser A A P
West Middlesex Hospital, Twickenham Rd, London, Middlesex, TW7 6AF, UK,
World J Surg. 2015 Mar;39(3):623-33. doi: 10.1007/s00268-014-2875-6.
The assessment of higher surgical training has changed in the last decade or two, with a greater emphasis on work-based assessments (WBAs) to prove competency. The aim of this study was to determine the evidence underpinning the use and number of WBAs in surgical training.
In July 2013, a systematic electronic literature review was undertaken using PubMed (Medline), Embase, Google Scholar and the Cochrane library.
A total of 27 studies met the inclusion criteria of which 25 were observational studies and only five assessed WBAs in a surgical setting. Validity and feasibility in surgical training were assessed in two studies, respectively, with the results suggesting that WBAs maybe neither feasible nor valid in surgical training. The number required to achieve reliability in surgical training was demonstrated to be three in two separate studies. The evidence for the reliability, feasibility and validity of WBAs in other non-surgical fields was conflicting.
There is a paucity of evidence supporting the use of WBAs as a tool to determine competency in surgical training, and as such, they should only have a limited role in training until more evidence is available. There appears to be no justification or evidence underpinning the use of a specific number of WBAs to determine surgical competency.
在过去的一二十年里，高等外科培训的评估方式发生了变化，更加强调基于工作的评估（WBA）以证明能力。本研究的目的是确定外科培训中使用WBA及其数量的依据。
2013年7月，使用PubMed（医学索引）、Embase、谷歌学术和考克兰图书馆进行了系统的电子文献综述。
共有27项研究符合纳入标准，其中25项为观察性研究，只有5项在外科环境中评估了WBA。分别有两项研究评估了外科培训中的有效性和可行性，结果表明WBA在外科培训中可能既不可行也无效。两项独立研究表明，在外科培训中要达到可靠性所需的WBA数量为三项。WBA在其他非外科领域的可靠性、可行性和有效性的证据相互矛盾。
缺乏证据支持将WBA作为确定外科培训能力的工具，因此，在有更多证据之前，它们在培训中的作用应有限。似乎没有理由或证据支持使用特定数量的WBA来确定外科能力。
