Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Am Coll Surg. 2016 Jun;222(6):1082-8. doi: 10.1016/j.jamcollsurg.2015.11.034. Epub 2015 Dec 20.
The ACGME requires general surgery residents (GSR) to perform 20 pediatric surgery cases as part of the total 750 cases before graduation.
We queried the ACGME General Surgery (1999 to 2014) and Pediatric Surgery (2003 to 2014) Case Logs for all pediatric operations performed during training. Means (±SD) and medians (10(th):90(th) percentiles) were compared, and R(2) was calculated for all trends.
The number of pediatric surgery fellows (PSF) increased 63% (23 to 39; R(2) = 0.82), while GSR numbers increased 12% (989 to 1,105; R(2) = 0.77). Total and average pediatric surgery case volume for GSR decreased from 39,309 to 32,156 (R(2) = 0.90) and 39.7 ± 13 to 29.1 ± 10 (R(2) = 0.91), respectively. Meanwhile, average PSF case volume increased from 980 ± 208 to 1,137 ± 202 (R(2) = 0.83). These trends persisted for inguinal/umbilical hernia (GSR 22.1 ± 13 to 15.6 ± 10; R(2) = 0.93; PSF 90.5 ± 17.6 to 104.4 ± 20.7; R(2) = 0.34), pyloric stenosis (GSR 3.9 ± 3 to 2.8 ± 3; R(2) = 0.60; PSF 29.6 ± 15 to 39.7 ± 16.8; R(2) = 0.69), and intestinal atresia (GSR 1.3 ± 2 to 1.1 ± 2; R(2) = 0.34; PSF 4.3 ± 4 to 11.8 ± 8; R(2) = 0.21). The mean number of GSR pediatric operations diminished for both junior (37.1 ± 20 to 27.3 ± 16; R(2) = 0.88) and chief (2.6 ± 5 to 1.7 ± 5; R(2) = 0.75) years. Teaching cases in pediatric surgery decreased at all levels. Although the percentage of GSR teaching cases performed during chief years fell modestly (6.6% to 4.7%; R(2) = 0.53), median teaching cases dropped from 2 (0:11 [10(th):90(th) percentiles]) to zero (0:0 [10(th):90(th) percentiles]). Mean PSF teaching cases declined (100.7 ± 396 to 44.5 ± 42; R(2) = 0.72), while the percentage of operations that were teaching cases decreased more sharply (10.3% to 3.5%; R(2) = 0.82).
Total pediatric surgery cases and PSF operative volume have increased, while GSR operative volume has decreased. Opportunities may exist to increase resident participation while providing further teaching opportunities for GSR, improving the quality of both resident and fellow training.
ACGME 要求普通外科住院医师（GSR）在毕业前完成 20 例儿科手术，作为总计 750 例中的一部分。
我们查询了 ACGME 普通外科（1999 年至 2014 年）和小儿外科（2003 年至 2014 年）的手术日志，以获取培训期间进行的所有儿科手术。对所有趋势进行比较，计算平均值（±SD）和中位数（第 10 百分位数：第 90 百分位数），并计算 R²。
小儿外科研究员（PSF）的数量增加了 63%（从 23 人增加到 39 人；R²=0.82），而 GSR 的数量增加了 12%（从 989 人增加到 1105 人；R²=0.77）。GSR 的总儿科手术量和平均手术量从 39309 例减少到 32156 例（R²=0.90），从 39.7±13 例减少到 29.1±10 例（R²=0.91）。同时，PSF 的平均手术量从 980±208 例增加到 1137±202 例（R²=0.83）。这些趋势在腹股沟/脐疝（GSR 22.1±13 例减少到 15.6±10 例；R²=0.93；PSF 90.5±17.6 例增加到 104.4±20.7 例；R²=0.34）、幽门狭窄（GSR 3.9±3 例减少到 2.8±3 例；R²=0.60；PSF 29.6±15 例增加到 39.7±16.8 例；R²=0.69）和肠闭锁（GSR 1.3±2 例减少到 1.1±2 例；R²=0.34；PSF 4.3±4 例增加到 11.8±8 例；R²=0.21）中持续存在。初级（37.1±20 例减少到 27.3±16 例；R²=0.88）和首席（2.6±5 例减少到 1.7±5 例；R²=0.75）年的 GSR 儿科手术数量减少。小儿外科的教学手术数量在各个层面都有所减少。尽管首席年 GSR 教学手术的比例略有下降（从 6.6%下降到 4.7%；R²=0.53），但中位数的教学手术数量从 2 例（0:11 [第 10 百分位数：第 90 百分位数]）下降到 0 例（0:0 [第 10 百分位数：第 90 百分位数]）。PSF 的平均教学手术量下降（从 100.7±396 例减少到 44.5±42 例；R²=0.72），而教学手术的比例下降更为明显（从 10.3%下降到 3.5%；R²=0.82）。
总的儿科手术数量和 PSF 的手术量增加了，而 GSR 的手术量减少了。可能存在增加住院医师参与度的机会，同时为 GSR 提供更多的教学机会，提高住院医师和研究员培训的质量。
