Kwakye Gifty, Chen Xiaodong Phoenix, Havens Joaquim M, Irani Jennifer L, Yule Steven, Smink Douglas S
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Surg Educ. 2015 Nov-Dec;72(6):1095-101. doi: 10.1016/j.jsurg.2015.07.003. Epub 2015 Aug 3.
Traditionally, surgical training has used an apprenticeship model but has more recently moved to a service-based model, with groups of residents working with groups of attending surgeons. We developed an apprenticeship rotation to enhance one-on-one interaction between chief residents and selected faculty. We hypothesized that the apprenticeship rotation would be effective for teaching nontechnical skills (NTS) and core competencies.
An apprenticeship rotation was created at a university-based surgery residency in which each chief resident selected a single attending surgeon with whom to work exclusively with for a 4-week period. Emphasis was placed on teaching intraoperative NTS as well as the 4 difficult-to-teach Accreditation Council for Graduate Medical Education core competencies (DCC): Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice. Participants were surveyed afterwards about their rotation using a 5-point Likert scale. A Wilcoxon signed rank test was used to compare differences depending on data distribution.
All (13/13) the chief residents and 67% (8/12) faculty completed the survey. Overall, 85% of residents and 87.5% of faculty would recommend the rotation to other residents/faculty members. Both residents and faculty reported improvement in trainees' technical skills and NTS. Residents reported improvement in all 4 DCC, particularly, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills.
The apprenticeship rotation is an effective means of teaching residents both NTS and DCC essential for independent practice. Consideration should be given to introducing this program into surgical curricula nationally.
传统上，外科培训采用学徒模式，但最近已转向基于服务的模式，住院医师团队与主治外科医生团队合作。我们开展了一次学徒轮转，以加强总住院医师与选定教员之间的一对一互动。我们假设这种学徒轮转对于教授非技术技能（NTS）和核心能力将是有效的。
在一所大学附属医院的外科住院医师培训中设置了一次学徒轮转，每位总住院医师选择一位主治外科医生，在为期4周的时间里专门与其合作。重点是教授术中非技术技能以及4项难以教授的毕业后医学教育认证委员会核心能力（DCC）：人际沟通技能、基于实践的学习与改进、职业素养和基于系统的实践。之后使用5点李克特量表对参与者进行关于他们轮转情况的调查。根据数据分布情况，使用Wilcoxon符号秩检验来比较差异。
所有（13/13）总住院医师和67%（8/12）的教员完成了调查。总体而言，85%的住院医师和87.5%的教员会向其他住院医师/教员推荐该轮转。住院医师和教员均报告学员的技术技能和非技术技能有所提高。住院医师报告在所有4项DCC方面均有提高，尤其是基于实践的学习与改进、职业素养以及人际沟通技能。
学徒轮转是教授住院医师独立执业所需的非技术技能和DCC的有效手段。应考虑在全国范围内将该项目引入外科课程。
