Yamamoto Satoshi, Tanaka Pedro, Madsen Matias V, Macario Alex
Department of Anesthesiology, University of Texas Medial Branch at Galveston.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine.
Cureus. 2017 Feb 26;9(2):e1060. doi: 10.7759/cureus.1060.
Little has been published comparing the graduate medical education training structure and requirements across multiple countries. The goal of this study was to summarize and compare the characteristics of anesthesiology training programs in the USA, UK, Canada, Japan, Brazil, Denmark, and Switzerland as a way to better understand efforts to train anesthesiologists in different countries. Two physicians trained in each of the seven countries (convenience sample) were interviewed using a semi-structured approach. The interview was facilitated by use of a predetermined questionnaire that included, for example, the duration of post-medical school training and national requirements for certain rotations, a number of cases, faculty supervision, national in-training written exams, and duty hour limits. These data were augmented by review of each country's publicly available residency training documents as available on the internet. Post-medical school anesthesia residency duration varied: three years (Brazil), four years (USA), five years (Canada and Switzerland), six years (Japan and Denmark) to nine years (UK), as did the number of explicitly required clinical rotations of a defined duration: zero (Denmark), one (Switzerland and UK), four (Brazil), six (Canada), and 12 (USA). Minimum case requirements exist in the USA, Japan, and Brazil, but not in the other countries. National written exams taken during training exist for all countries studied except Japan and Denmark. The countries studied increasingly aim to have competency-based education with milestone assessments. Training duty hour limits also varied including for example 37 hours/week averaged over a one month with limitations on night duties (Denmark), a weekly average of 48 hours taken over a 17 week period (UK), 50 hours/week maximum (Switzerland), 60 hours/week maximum (Brazil), and 80 hours/week averaged over four weeks (USA). Some countries have highly structured training programs with multiple national requirements with training principally carried out at a home institution. Other countries have a more decentralized and unregulated approach with fewer (if any) specific case or rotation requirements, where the trainee creates his/her own customized training to meet broad objectives and goals. The countries studied have different national training requirements, unique duty hour rules and are at varying stages in transitioning to an outcome based model of residency.
关于比较多个国家毕业后医学教育培训结构和要求的文献报道较少。本研究的目的是总结和比较美国、英国、加拿大、日本、巴西、丹麦和瑞士麻醉学培训项目的特点，以便更好地了解不同国家麻醉医师的培训情况。采用半结构化方法对七个国家（便利样本）中各两名接受过培训的医生进行了访谈。访谈通过使用预先确定的问卷进行，问卷内容包括例如医学院毕业后培训的时长以及某些轮转、病例数量、教员监督、全国在职笔试和值班时长限制等方面的国家要求。通过查阅互联网上每个国家公开的住院医师培训文件对这些数据进行了补充。医学院毕业后麻醉住院医师培训时长各不相同：三年（巴西）、四年（美国）、五年（加拿大和瑞士）、六年（日本和丹麦）至九年（英国），明确规定时长的临床轮转数量也不同：零（丹麦）、一（瑞士和英国）、四（巴西）、六（加拿大）和十二（美国）。美国、日本和巴西存在最低病例要求，而其他国家则没有。除日本和丹麦外，所有研究国家在培训期间都设有全国性笔试。研究中的国家越来越倾向于开展基于能力的教育并进行里程碑评估。培训值班时长限制也各不相同，例如丹麦在一个月内平均每周37小时且限制夜间值班，英国在17周内平均每周48小时，瑞士每周最多50小时，巴西每周最多60小时，美国在四周内平均每周80小时。一些国家的培训项目结构高度规范，有多项国家要求，培训主要在国内机构进行。其他国家的培训方式则更为分散且缺乏规范，具体病例或轮转要求较少（如果有的话），学员自行制定个性化培训以实现广泛的目标。研究中的国家有不同的国家培训要求、独特的值班时长规定，并且在向基于结果的住院医师培训模式转变的过程中处于不同阶段。
