Trudeau Maeve O'Neill, Swaroop Mamta, Rothstein David H
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Trauma and Critical Care Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
J Surg Res. 2016 Jun 15;203(2):319-23. doi: 10.1016/j.jss.2016.04.042. Epub 2016 Apr 25.
Although interest in practicing surgery in resource-constrained settings is on the rise among graduating US surgical residents, there is ongoing debate about an optimal humanitarian skill set for surgeons who chose to work in such settings. In addition, increased emphasis on general surgery case exposure at the cost of specialty surgery case exposure has been documented and may have a negative impact on the breadth of resident training. Review of general surgery resident case logs to gauge experience in specialty surgery may provide insight into residents' readiness for work in resource-limited settings.
We compared Accreditation Council for Graduate Medical Education general surgery resident case logs from 2004 to 2014 for operations thought to be essential for working in resource-constrained settings. These operations were chosen from published literature on this topic and authors' personal experience. Case numbers for specialty operations were compared by unpaired t-test analysis between the two periods.
Case averages in pediatric, genitourinary, and gynecologic surgery decreased significantly from 2004 to 2014 (range, 27%-46%). Orthopedic surgery case averages were unchanged, and plastic and general abdominal surgery case averages increased (range, 47%-50%).
Case mix among graduating US surgical residents has narrowed over the past 10 y. Resident experience in a variety of specialty fields, thought to be essential in resource-constrained settings, decreased markedly over the study period. Residents who intend to work in resource-constrained settings may need to craft individualized residency experiences or pursue postgraduate training in specialty surgery courses to best prepare for such work.
尽管美国即将毕业的外科住院医师对在资源有限的环境中开展手术的兴趣日益浓厚，但对于选择在这种环境中工作的外科医生而言，最佳人道主义技能组合仍存在争议。此外，有文献记载，以牺牲专科手术病例接触为代价，增加对普通外科病例接触的强调，可能会对住院医师培训的广度产生负面影响。审查普通外科住院医师的病例记录以评估其在专科手术方面的经验，可能有助于了解住院医师在资源有限环境中工作的准备情况。
我们比较了2004年至2014年毕业后医学教育认证委员会普通外科住院医师的病例记录，这些记录涉及被认为在资源有限环境中工作所必需的手术。这些手术是从关于该主题的已发表文献和作者的个人经验中挑选出来的。通过对两个时期之间的未配对t检验分析，比较专科手术的病例数。
2004年至2014年，儿科、泌尿生殖科和妇科手术的平均病例数显著下降（范围为27% - 46%）。骨科手术的平均病例数没有变化，整形外科和普通腹部手术的平均病例数有所增加（范围为47% - 50%）。
在过去10年中，即将毕业的美国外科住院医师的病例组合有所变窄。在研究期间，被认为在资源有限环境中至关重要的各种专科领域的住院医师经验显著减少。打算在资源有限环境中工作的住院医师可能需要制定个性化的住院医师培训经历，或参加专科手术课程的研究生培训，以便为这类工作做好最佳准备。
