Maqsood Hadia, Buddensick Thomas J, Patel Kalpesh, Ferdosi Hamid, Sautter Amanda, Setiawan Lisa, Sill Anne M, Kowdley Gopal C, Cunningham Steven C
The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
The Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
J Surg Educ. 2016 Sep-Oct;73(5):836-43. doi: 10.1016/j.jsurg.2016.04.005. Epub 2016 May 18.
To better understand important aspects of resident education in the perioperative setting, given that there are conflicting data regarding resident training and outcomes (e.g., operative times and complications). To study continuity of care in a resident-run outpatient hospital clinic.
Retrospective analysis of 2 databases.
The study was set up in a community teaching hospital.
Of 4603 cases in a cholecystectomy database, 3302 (72%) were assisted by residents, with operative times ranging from 19 to 383 minutes, and 1576 (22.9%) were assisted by nonresidents. The average times were 93 and 77 minutes for resident- and non-resident-assisted cases, respectively. Complications were almost 3 times more likely for urgent vs. elective but were similar for resident-assisted vs. non-resident-assisted cases. The operative time was similar across PGY levels. Of 149 cases in a resident-run outpatient clinic, 100 (67%) of the residents participated in preoperative, intraoperative, and postoperative phases of case, but in only 4% of cases was it the same resident.
Resident assistance increased operative times but not complications. Counterbalanced effects of increasing skill and increasing participation may explain this time stability across PGY levels. Continuity of care is preserved in the era of the 80-hour workweek, but not to a patient-specific degree.
鉴于围手术期住院医师培训与结果（如手术时间和并发症）的数据存在冲突，更好地了解围手术期住院医师培训的重要方面。研究住院医师管理的门诊医院诊所的护理连续性。
对两个数据库进行回顾性分析。
研究在一家社区教学医院开展。
在胆囊切除术数据库的4603例病例中，3302例（72%）由住院医师协助，手术时间从19分钟到383分钟不等，1576例（22.9%）由非住院医师协助。住院医师协助和非住院医师协助病例的平均时间分别为93分钟和77分钟。急诊手术的并发症发生率几乎是非急诊手术的3倍，但住院医师协助和非住院医师协助病例的并发症发生率相似。不同住院医师培训阶段的手术时间相似。在住院医师管理的门诊诊所的149例病例中，100例（67%）住院医师参与了病例的术前、术中和术后阶段，但只有4%的病例是由同一名住院医师参与。
住院医师协助增加了手术时间，但未增加并发症。技能提高和参与度增加的平衡效应可能解释了不同住院医师培训阶段手术时间的稳定性。在每周80小时工作制的时代，护理连续性得以保持，但未达到针对特定患者的程度。
