Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Department of Medicine, University of Toronto, Toronto, Canada.
Ann Surg. 2018 Jul;268(1):77-85. doi: 10.1097/SLA.0000000000002363.
To gain contemporary insights from residents and surgeons regarding the care of older surgical patients.
With worldwide aging, efforts over the past decade have attempted to increase surgeons' abilities to care for older adults, but a current understanding of attitudes, knowledge, practices, and needs is missing.
Between July 2016 and September 2016 we conducted a national Web-based survey sampling all general surgery residents and academic general surgeons using a questionnaire designed and tested for this purpose. Summative scales within each domain (attitudes, knowledge, practices, and needs) were created and compared between groups. Open-ended responses were analyzed with thematic analysis.
Ninety-four of 172 invited residents (55%) and 80 of 243 invited surgeons (33%) across 14 general surgery programs responded with no missing data. Both groups had favorable attitudes (83% vs 68%, P = 0.02). However, 80% of residents and 76% of surgeons had medium-level knowledge test scores, and few had prior training. Most respondents reported only sometimes performing guideline-recommended practices (71% vs 73%, P = 0.55). Gaps in training and care delivery were identified. Residents wanted focused, high-yield materials and case-oriented practical skills training. Respondents reported further improvements may come from building surgeons' capacity, enhancing collaboration including perioperative geriatric services, better preoperative assessment, increased adherence to perioperative guidelines, and greater community-based supports to recovery.
Residents and surgeons have favorable attitudes, but only moderate geriatric-specific knowledge and only some guideline-adherent practices. We identified gaps in training and care delivery with targets for future knowledge translation and quality improvement initiatives.
从住院医师和外科医生的角度了解当前老年患者的治疗情况。
随着全球人口老龄化，过去十年中，人们一直在努力提高外科医生照顾老年人的能力，但目前尚不清楚他们的态度、知识、实践和需求。
2016 年 7 月至 9 月，我们采用为此目的设计和测试的问卷，通过网络对所有普通外科住院医师和学术普通外科医生进行了全国性抽样调查。在每个领域（态度、知识、实践和需求）内创建综合量表，并对组间进行比较。使用主题分析法对开放式回答进行分析。
在 14 个普通外科项目中，邀请了 172 名住院医师中的 94 名（55%）和 243 名外科医生中的 80 名（33%）做出了回应，且没有缺失数据。两组的态度都很积极（83%对 68%，P=0.02）。然而，80%的住院医师和 76%的外科医生知识测试成绩处于中等水平，且很少有人接受过相关培训。大多数受访者报告说，他们只是偶尔执行指南推荐的做法（71%对 73%，P=0.55）。调查发现了培训和护理方面的差距。住院医师希望获得有针对性、高收益的材料和以病例为导向的实用技能培训。受访者报告称，进一步的改进可能来自于增强外科医生的能力、加强包括围手术期老年服务在内的合作、更好的术前评估、增加对围手术期指南的遵循以及加强社区康复支持。
住院医师和外科医生的态度较为积极，但他们的老年医学专业知识仅处于中等水平，且仅部分实践符合指南。我们发现了培训和护理方面的差距，这为未来的知识转化和质量改进举措提供了目标。
