Burlew Clay Cothren, Davis Kimberly A, Fildes John J, Esposito Thomas J, Dente Christopher J, Jurkovich Gregory J
From the Department of Surgery (C.C.B.), Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado; Yale School of Medicine (K.A.D.), New Haven, Connecticut; University of Nevada (J.L.F.), Reno, Nevada; Emory University at Grady Memorial Hospital (C.J.D.), Atlanta, Georgia; and UC Davis (G.J.J.), Davis, California.
J Trauma Acute Care Surg. 2017 Jan;82(1):208-210. doi: 10.1097/TA.0000000000001309.
Over the past decade, the American Association for the Surgery of Trauma Acute Care Surgery (ACS) fellowship program has matured to 20 verified programs. As part of an ongoing curricular evaluation, we queried the current practice patterns of the graduates of ACS fellowship programs regarding their view on their ACS training. We hypothesized that the majority of ACS fellowship graduates would be practicing ACS in academic Level I trauma centers and that fellowship training was pivotal in their career.
Graduates of American Association for the Surgery of Trauma-certified ACS fellowships completed an online survey that included practice demographics, specific categories of cases delineated by the current ACS curriculum, and perceived impact of training.
Surveys were submitted by 56 of 77 graduates for a completion rate of 73%. The majority of respondents were male (68%) aged 40 years or younger (80%). All but four completed ACS fellowship training in last 5 years (93%), and 83% completed fellowship in the last 3 years. Regarding their current practice, broadly defined ACS predominated (96%) with 2% practicing only trauma surgery and 2% only general surgery. Practice settings were 64% urban, 29% suburban, and 7% rural locations, with 84% of graduates practicing in a hospital-based group. The practitioner's hospital was identified as university/university-affiliated in 53%, community in 38%, and military in 9%, with 91% identified as a teaching hospital; trauma designation was identified as Level I (55%), Level II (39%), and other (6%). The graduates' average current practice mix is 10% elective general surgery, 29% emergency general surgery, 32% trauma, 25% surgical critical care, and 4% other (burn, bariatric, vascular, and thoracic). Only 16% of graduates do not perform elective cases. Case specifics demonstrated 92% of graduates perform vascular cases, 88% perform thoracic cases, and 70% perform complex hepatobiliary. Practice elements that were satisfiers included (1) scope of practice, (2) case mix, (3) percentage emergency general surgery, (4) lifestyle, (5) case complexity (with 3 and 4 tied). Graduates agreed the ACS fellowship training prepared them well for practice and was worth the time invested (both 82%), increased their marketability and self-confidence (80%), and prepared them well for academics (71%) and administration (63%). Of those surveyed, 93% would encourage others to do an ACS fellowship.
Although 93% of graduates practice in urban/suburban areas, there was a mixture of university, university-affiliated, and community institutions and an almost even division of Levels I and II designation. Graduates demonstrate ongoing use of their acquired advanced operative training, particularly in vascular and thoracic surgery. The majority of ACS fellowship graduates were practicing ACS and felt fellowship training was valuable in their career path and that they would recommend it to others.
在过去十年中，美国创伤外科协会急性 care 外科（ACS） fellowship 项目已发展成熟至 20 个已获认证的项目。作为正在进行的课程评估的一部分，我们询问了 ACS fellowship 项目毕业生关于他们对 ACS 培训看法的当前实践模式。我们假设大多数 ACS fellowship 毕业生会在学术一级创伤中心从事 ACS 工作，并且 fellowship 培训对他们的职业生涯至关重要。
美国创伤外科协会认证的 ACS fellowship 项目的毕业生完成了一项在线调查，该调查包括实践人口统计学、当前 ACS 课程所界定的特定病例类别以及培训的感知影响。
77 名毕业生中有 56 人提交了调查问卷，完成率为 73%。大多数受访者为男性（68%），年龄在 40 岁及以下（80%）。除 4 人外，所有受访者均在过去 5 年完成了 ACS fellowship 培训（93%），83%在过去 3 年完成了 fellowship 培训。关于他们当前的实践，广义定义的 ACS 占主导（96%），2%仅从事创伤外科，2%仅从事普通外科。实践地点为城市地区占 64%，郊区占 29%，农村地区占 7%，84%的毕业生在医院集团工作。从业者所在医院被确定为大学/大学附属医院的占 53%，社区医院占 38%，军队医院占 9%，91%被确定为教学医院；创伤指定为一级（55%）、二级（39%）和其他（6%）。毕业生当前的平均实践组合为择期普通外科占 10%，急诊普通外科占 29%，创伤占 32%，外科重症监护占 25%，其他（烧伤、肥胖症、血管和胸科）占 4%。只有 16%的毕业生不进行择期病例。病例详情显示，92%的毕业生进行血管病例，88%进行胸科病例，70%进行复杂肝胆病例。令人满意的实践要素包括：（1）实践范围，（2）病例组合，（3）急诊普通外科的比例，（4）生活方式，（5）病例复杂性（3 和 4 并列）。毕业生们一致认为 ACS fellowship 培训使他们为实践做好了充分准备，并且值得投入时间（均为 82%），提高了他们的市场竞争力和自信心（80%），并使他们为学术（71%）和管理（63%）做好了充分准备。在接受调查的人中，93%会鼓励其他人参加 ACS fellowship。
尽管 93%的毕业生在城市/郊区地区工作，但存在大学、大学附属医院和社区机构的混合情况，一级和二级指定几乎平分秋色。毕业生们展示了他们所获得的高级手术培训的持续应用，特别是在血管和胸外科方面。大多数 ACS fellowship 毕业生从事 ACS 工作，并认为 fellowship 培训在他们的职业道路上很有价值，并且他们会向其他人推荐。
