Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
J Surg Educ. 2018 May-Jun;75(3):541-545. doi: 10.1016/j.jsurg.2017.08.025. Epub 2017 Oct 31.
Among surgical educators, duty-hour restrictions led to concern regarding the adequacy of operative experience during residency, especially for junior residents. The American Board of Surgery recently instituted guidelines mandating "a minimum of 250 operations by the end of the PGY-2 year". A series of programmatic and institutional changes were implemented at our institution to augment the junior resident operative experience and to exceed compliance with this mandate.
Operative data from Accreditation Council for Graduate Medical Education case logs for categorical and nondesignated preliminary interns from our large academic surgical residency were identified for 5 consecutive academic years, 2011 until 2016. American Board of Surgery In-Training Examination (ABSITE) scores were collected anonymously. The program systematically instituted the following changes: night float minimization, identification of new surgical opportunities, augmenting use of midlevel care providers, identification of rotations with suboptimal operative experiences, maximizing rotations with involvement of junior residents in the operating room, and systematic review of junior case logs.
After implementation, average total cases for residents completing postgraduate year (PGY)-2 increased from 176 to 330 (p < 0.001). Specifically, there was an 18% increase for interns (p = 0.059) and a 118% increase for PGY-2 residents (p < 0.001). There were statistically significant increases in skin and soft tissue cases, vascular cases, endoscopy, and complex laparoscopic cases. Average case volumes for senior residents did not change. Night float time was significantly decreased (5.7 vs 3.4 wk; p = 0.04). ABSITE scores were not significantly changed during this time.
Before implementation of these interventions, our program would have had 0% compliance with the 250 junior resident case rule. Within 12 months of implementation, total case volumes for residents completing PGY-2 increased by 88%-exceeding minimum standards. Overall, 100% programmatic compliance was achieved. Our program's experience exemplifies how mandates from the American Board of Surgery can lead to programmatic changes that improve the experience of surgical house officers.
在外科教育者中，工时限制导致人们对住院医师培训期间手术经验的充足性感到担忧，尤其是对初级住院医师而言。美国外科学委员会最近发布了指导方针，规定“在 PGY-2 年末，至少要完成 250 例手术”。为了增加初级住院医师的手术经验并达到遵守这一规定的要求，我们机构实施了一系列计划和机构改革。
从我们大型学术外科住院医师培训计划的分类和非指定初级实习住院医师的研究生医学教育认证委员会病例记录中确定了连续 5 个学年（2011 年至 2016 年）的手术数据。匿名收集了美国外科学委员会住院医师考试（ABSITE）成绩。该计划系统地进行了以下更改：减少夜班轮班、寻找新的手术机会、增加中级护理人员的使用、确定手术经验不足的轮换、最大限度地增加有初级住院医师参与的轮换以及对初级住院医师病例记录进行系统审查。
实施后，完成住院医师第二年（PGY-2）的住院医师的平均总手术量从 176 例增加到 330 例（p < 0.001）。具体来说，实习住院医师的手术量增加了 18%（p = 0.059），PGY-2 住院医师的手术量增加了 118%（p < 0.001）。皮肤和软组织手术、血管手术、内窥镜检查和复杂腹腔镜手术的数量均有统计学显著增加。高级住院医师的手术量没有变化。夜班轮班时间显著减少（5.7 周与 3.4 周；p = 0.04）。在此期间，ABSITE 成绩没有显著变化。
在实施这些干预措施之前，我们的计划将有 0%符合 250 例初级住院医师手术规则的要求。在实施后的 12 个月内，完成 PGY-2 的住院医师的总手术量增加了 88%-超过了最低标准。总体而言，该计划实现了 100%的合规性。我们计划的经验证明了美国外科学委员会的指令如何导致计划的改变，从而改善外科住院医师的体验。
