Stephens Elizabeth H, Walters Dustin M, Eilers Amanda L, Tchantchaleishvili Vakhtang, Goldstone Andrew B, Gillaspie Erin A, Fiedler Amy, LaPar Damien J
Columbia University Medical Center, New York, New York.
University of Virginia, Charlottesville, Virginia.
Ann Thorac Surg. 2017 Jun;103(6):1984-1991. doi: 10.1016/j.athoracsur.2017.01.079. Epub 2017 Apr 24.
Development of curricula that appropriately progress a resident from medical school graduate to fully trained cardiothoracic surgeon is a key challenge for integrated cardiothoracic training programs. This study examined variability and perceived challenges in integrated curricula.
Responses to the 2016 TSDA/TSRA survey that accompanies the annual in-training exam taken by current cardiothoracic surgery residents were analyzed. Standard statistical methods were utilized to examine trends in participant responses.
General surgery experience decreased with post-graduate year, whereas cardiac operative experience increased. Rotations in a wide variety of adjunct fields were common. The majority (87%) of respondents reported had dedicated cardiothoracic intensive care unit (ICU) rotations, and surgical ICU and cardiac care unit rotations were less common (68% and 42%, respectively). The most common surgical subspecialty rotations were vascular (94%) and acute care surgery (88%), with a wide range of clinical exposure (ie, 3-44 weeks for vascular). Importantly, 52% felt competition with general surgery residents for experience and 22.5% of general surgery rotations were at hospitals without general surgery residents. Perceived challenges included optimization of rotations (78%), faculty allowing residents to perform case components (60%), faculty teaching in the operating room (29%), and improving surgical experience on general surgery rotations (19%).
Significant variation exists in integrated cardiothoracic surgery curricula. Optimization of rotations, access to surgical experience, and integration with general surgery appear to be the most significant perceived challenges. These data suggest that optimization of early clinical and surgical experience within institutions could improve trainee preparedness for senior cardiothoracic surgery training.
制定能够让住院医师从医学院毕业生顺利成长为训练有素的心胸外科医生的课程体系，是心胸外科综合培训项目面临的一项关键挑战。本研究调查了综合课程体系中的差异及所察觉到的挑战。
分析了对2016年心胸外科住院医师年度在训考试所附带的TSDA/TSRA调查问卷的回复。运用标准统计方法来研究参与者回复中的趋势。
普通外科经验随研究生年级的升高而减少，而心脏手术经验则增加。在各种各样的辅助领域进行轮转很常见。大多数（87%）受访者表示有专门的心胸重症监护病房（ICU）轮转经历，而外科ICU和心脏监护病房轮转则较少见（分别为68%和42%）。最常见的外科亚专科轮转是血管外科（94%）和急症手术（88%），临床接触范围广泛（例如，血管外科为3 - 44周）。重要的是，52%的人觉得与普通外科住院医师竞争经验，且22.5%的普通外科轮转是在没有普通外科住院医师的医院进行的。所察觉到的挑战包括优化轮转（78%）、教员允许住院医师参与病例组成部分（60%）、教员在手术室教学（29%）以及改善普通外科轮转中的手术经验（19%）。
心胸外科综合课程体系存在显著差异。轮转优化、获得手术经验以及与普通外科的整合似乎是所察觉到的最重大挑战。这些数据表明，在机构内部优化早期临床和手术经验可以提高学员为高级心胸外科培训做好准备的程度。
