Bowyer Mark W, Shackelford Stacy A, Garofalo Evan, Pugh Kristy, Mackenzie Colin F
The Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
USAF Center for Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
J Surg Res. 2015 Oct;198(2):280-8. doi: 10.1016/j.jss.2015.03.082. Epub 2015 Apr 1.
Experience with the management of vascular trauma by senior surgical residents is increasingly limited. When queried about their understanding of anatomy and ability to perform specific vascular exposures, residents express a moderately high level of confidence. We hypothesized that this perception does not equal reality.
A total of 42 senior surgical residents participating in an ongoing validation study of the Advanced Surgical Skills for Exposures in Trauma course were asked to self-assess their baseline (precourse) confidence of their understanding of the anatomy required to perform and their ability to perform exposure and control of the axillary, brachial, and femoral arteries, as well as lower extremity fasciotomy using a 5-point Likert scale. Residents then performed the four procedures on a fresh cadaver model and were scored in real time by experts using a global assessment of anatomic knowledge and readiness to perform." The Student t-test was used with α set at P < 0.05.
Residents consistently rated their understanding of anatomy and their ability to perform the procedures significantly higher than expert evaluator ultimately scored them. Evaluators also deemed that residents would be unable to perform without help 65%-86% of the time.
Senior residents are ill-prepared to perform the procedures studied and have an unwarranted confidence in their knowledge and abilities. Perception clearly does not equal reality in preparing these trainees to perform as advertized. The low global scores for anatomy and performance should be a wake-up call for surgical educators prompting curricular reform and evaluation.
高级外科住院医师处理血管创伤的经验越来越有限。当被问及他们对解剖学的理解以及进行特定血管暴露的能力时，住院医师表现出中等偏高的信心水平。我们推测这种认知与实际情况不符。
共有42名参与创伤暴露高级外科技能课程正在进行的验证研究的高级外科住院医师，被要求使用5分制李克特量表自我评估他们对执行所需解剖学知识的理解以及进行腋窝、肱动脉和股动脉暴露与控制，以及下肢筋膜切开术的基线（课程前）信心。然后，住院医师在新鲜尸体模型上进行这四项操作，并由专家使用解剖学知识和操作准备情况的整体评估进行实时评分。使用α设定为P < 0.05的Student t检验。
住院医师对自己解剖学理解和操作能力的评分一直显著高于专家评估者最终给出的评分。评估者还认为，住院医师在65% - 86%的时间里没有他人帮助将无法完成操作。
高级住院医师在准备进行所研究的操作方面准备不足，并且对自己的知识和能力有不恰当的信心。在让这些受训者按宣传的那样进行操作方面，认知显然与实际情况不符。解剖学和操作的整体低分应该给外科教育工作者敲响警钟，促使他们进行课程改革和评估。
