M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-6800-3932. L. Regan is associate professor, vice chair of education, and residency director, Department of Emergency Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; ORCID: http://orcid.org/0000-0003-0390-4243. J. Branzetti is assistant professor and residency director, Department of Emergency Medicine, New York University School of Medicine, New York, New York; ORCID: http://orcid.org/0000-0002-2397-0566. L.R. Hopson is associate professor and residency director, Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0003-1745-0836.
Acad Med. 2018 May;93(5):699-704. doi: 10.1097/ACM.0000000000002062.
There is growing competition for nonoperative, procedural training in teaching hospitals, due to an increased number of individuals seeking to learn procedures from a finite number of appropriate teaching cases. Procedural training is required by students, postgraduate learners, and practicing providers who must maintain their skills. These learner groups are growing in size as the number of medical schools increases and advance practice providers expand their skills to include complex procedures. These various learner needs occur against a background of advancing therapeutic techniques that improve patient care but also act to reduce the overall numbers of procedures available to learners. This article is a brief review of these and other challenges that are arising for program directors, medical school leaders, and hospital administrators who must act to ensure that all of their providers acquire and maintain competency in a wide array of procedural skills. The authors conclude their review with several recommendations to better address procedural training in this new era of learner competition. These include a call for innovative clinical rotations deliberately designed to improve procedural training, access to training opportunities at new clinical sites acquired in health system expansions, targeted faculty development for those who teach procedures, reporting of competition for bedside procedures by trainees, more frequent review of resident procedure and case logs, and the creation of an institutional oversight committee for procedural training.
由于寻求从有限数量的适当教学病例中学习手术的人数增加，非手术性手术培训在教学医院的竞争日益激烈。学生、研究生学员和执业提供者都需要进行手术培训，他们必须保持自己的技能。随着医学院数量的增加以及实践提供者扩大其技能以包括复杂手术，这些学习者群体的规模不断扩大。这些不同的学习者需求是在治疗技术不断进步的背景下产生的，这些技术提高了患者的护理水平，但也减少了学习者可获得的手术数量。本文简要回顾了这些以及其他挑战，这些挑战是针对项目主管、医学院领导和医院管理人员提出的，他们必须采取行动，确保所有提供者都掌握广泛的手术技能并保持其能力。作者在回顾结束时提出了一些建议，以更好地应对这个新的学习者竞争时代的手术培训。这些建议包括呼吁精心设计创新的临床轮转，以改善手术培训，获得在卫生系统扩展中获得的新临床站点的培训机会，针对教授手术的教师进行有针对性的教师发展，培训生报告床边手术的竞争，更频繁地审查住院医师的手术和病例记录，以及为手术培训创建机构监督委员会。
