Silvestre Jason, Lin Ines C, Levin Lawrence Scott, Chang Benjamin
Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Educ. 2017 Jul-Aug;74(4):650-655. doi: 10.1016/j.jsurg.2016.12.001. Epub 2017 Mar 29.
Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs.
Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015.
Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015.
Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation.
在整形外科住院医师培训期间，实现手部手术培训标准化的努力仍然具有挑战性。我们分析了美国整形外科住院医师培训项目中手术手部经验的变异性。
对美国认可的整形外科住院医师培训项目中住院总医师的手术病例记录进行分析（2011 - 2015年）。以图形方式评估住院医师第10百分位数和第90百分位数之间手部手术病例数量倍数差异的趋势。使用百分位数数据计算2015年达到手部手术最低病例数的住院医师人数。
分析了818名整形外科住院医师的病例记录，其中少数来自综合项目（35.7%），而独立/联合项目的住院医师占比为64.3%。病例数量倍数差异的趋势分析表明，随着时间推移，各手术类别之间的变异性在降低。到2015年，手部重建、肌腱病例、神经病例、关节成形术/关节固定术、截肢、动脉修复、掌腱膜松解术和肿瘤病例的倍数差异低于10倍。2015年，独立/联合项目住院医师中的先天性畸形病例是唯一超过10倍的类别。百分位数数据表明，2015年约10%的独立/联合项目住院医师未达到动脉修复和先天性畸形的最低病例数。
整形外科住院医师培训期间手术经验的差异可能会限制某些住院医师对手部手术的充分接触。未来的研究应确定整形外科住院医师的经验病例最低数，以确保他们毕业后具备手部手术能力。
