Shalhoub Joseph, Santos Cristel, Bussey Maria, Eardley Ian, Allum William
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Joint Committee on Surgical Training, Royal College of Surgeons of England, London, United Kingdom.
J Surg Educ. 2015 Sep-Oct;72(5):786-94. doi: 10.1016/j.jsurg.2015.03.019. Epub 2015 May 14.
Workplace-based assessments (WBAs) were introduced formally in the UK in 2007. The aim of the study was to describe the use of WBAs by UK surgical trainees and examine variations by training region, specialty, and level of training.
The database of the Intercollegiate Surgical Curriculum Programme was examined for WBAs between August 2007 and July 2013, with in-depth analysis of 2 periods: August 2011 to July 2012 and August 2012 to July 2013.
The numbers of validated WBAs per trainee per year increased more than 7-fold, from median 6 per trainee in 2007 to 2008, to 39 in 2011 to 2012, and 44 in 2012 to 2013. In the period 2011 to 2012, 58.4% of core trainees completed the recommended 40 WBAs, with only 38.1% of specialty trainees achieving 40 validated WBAs. In the period 2012 to 2013, these proportions increased to 67.7% and 57.0% for core and specialty trainees, respectively. Core trainees completed more WBAs per year than specialty trainees in the same training region. London core trainees completed the highest numbers of WBAs in both the periods 2011 to 2012 (median 67) and 2012 to 2013 (median 74). There was a peak in WBAs completed by London specialty trainees in the period 2012 to 2013 (median 63). The most validated WBAs were completed by ST1/CT1 (specialty surgical training year, core surgical training year), with a gradual decrease in median WBAs to ST4, followed by a plateau; in the period 2012 to 2013, there was an increase in WBAs at ST8. Core surgical trainees complete ~50% "operative" (procedure-based assessment/direct observation of procedural skills) and ~50% "nonoperative" assessments (case-based discussion/clinical evaluation exercise). During specialty training, procedure-based assessments represented ~46% of WBAs, direct observation of procedural skills 11.2%, case-based discussion ~23%, and clinical evaluation exercise ~15%.
UK surgical trainees are, on an average, undertaking 1 WBA per week. Variation exists in use of WBAs between training regions. Core trainees tend to use the spectrum of WBAs more frequently than their senior colleagues do. Further work is required to examine the role of WBAs in assessment, and engagement and training of trainers in processes and validation of WBAs.
基于工作场所的评估（WBA）于2007年在英国正式引入。本研究的目的是描述英国外科住院医师对WBA的使用情况，并考察培训地区、专业和培训水平之间的差异。
对跨学院外科课程计划的数据库进行审查，以获取2007年8月至2013年7月期间的WBA数据，并对2011年8月至2012年7月和2012年8月至2013年7月这两个时间段进行深入分析。
每位住院医师每年经过验证的WBA数量增加了7倍多，从2007年至2008年每位住院医师的中位数6次增加到2011年至2012年的39次，以及2012年至2013年的44次。在2011年至2012年期间，58.4%的核心住院医师完成了推荐的40次WBA，只有38.1%的专科住院医师完成了40次经过验证的WBA。在2012年至2013年期间，核心住院医师和专科住院医师的这一比例分别增至67.7%和57.0%。在同一培训地区，核心住院医师每年完成的WBA比专科住院医师更多。伦敦的核心住院医师在2011年至2012年期间（中位数67次）和2012年至2013年期间（中位数74次）完成的WBA数量最多。2012年至2013年期间，伦敦专科住院医师完成的WBA数量达到峰值（中位数63次）。经过验证次数最多的WBA由ST1/CT1（专科外科培训年、核心外科培训年）完成，中位数WBA次数逐渐减少至ST4，随后趋于平稳；在2012年至2013年期间，ST8的WBA次数有所增加。核心外科住院医师完成约50%的“手术”（基于操作的评估/对操作技能的直接观察）和约50%的“非手术”评估（基于病例的讨论/临床评估练习）。在专科培训期间，基于操作的评估占WBA的约46%，对操作技能的直接观察占11.2%，基于病例的讨论约占23%，临床评估练习约占15%。
英国外科住院医师平均每周进行1次WBA。培训地区之间在WBA的使用上存在差异。核心住院医师比他们的上级同事更频繁地使用各种WBA。需要进一步开展工作，以考察WBA在评估中的作用，以及培训师在WBA流程和验证方面的参与和培训情况。
