University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA.
Medical College of Wisconsin, Milwaukee, WI, USA.
Surg Endosc. 2018 Jun;32(6):2613-2619. doi: 10.1007/s00464-018-6020-8. Epub 2018 Jan 17.
The American health care system faces deficits in quality and quantity of surgeons. SAGES is a major stakeholder in surgical fellowship training and is responsible for defining the curriculum for the Advanced GI/MIS fellowship. SAGES leadership is actively adapting this curriculum.
The process of reform began in 2014 through a series of iterative meetings and discussions. A working group within the Resident and Fellow Training Committee reviewed case log data from 2012 to 2015. These data were used to propose new criteria designed to provide adequate exposure to core content. The working group also proposed using video assessment of an MIS case to provide objective assessment of competency.
Case log data were available for 326 fellows with a total of 85,154 cases logged (median 227 per fellow). The working group proposed new criteria starting with minimum case volumes for five defined categories including foregut (20), bariatrics (25), inguinal hernia (10), ventral hernia (10), and solid organ/colon/thoracic (10). Fellows are expected to perform an additional 75 complex MIS cases of any category for a total of 150 required cases overall. The proposal also included a minimum volume of flexible endoscopy (50) and submission of an MIS foregut case for video assessment. The new criteria more clearly defined which surgeon roles count for major credit within individual categories. Fourteen fellowships volunteered to pilot these new criteria for the 2017-2018 academic year.
The new SAGES Advanced GI/MIS fellowship has been crafted to better define the core content that should be contained in these fellowships, while still allowing sufficient heterogeneity so that individual learners can tailor their training to specific areas of interest. The criteria also introduce innovative, evidence-based methods for assessing competency. Pending the results of the pilot program, SAGES will consider broad implementation of the new fellowship criteria.
美国的医疗保健系统在外科医生的质量和数量方面存在不足。 SAGES 是外科住院医师培训的主要利益相关者，负责为高级胃肠道/微创外科住院医师培训制定课程。 SAGES 的领导层正在积极调整这一课程。
改革的过程始于 2014 年，通过一系列的迭代会议和讨论。住院医师和研究员培训委员会内的一个工作组审查了 2012 年至 2015 年的病例记录数据。这些数据被用于提出新的标准，旨在提供对核心内容的充分接触。工作组还提议使用微创外科病例的视频评估来提供能力的客观评估。
有 326 名研究员的病例记录数据可用，总共记录了 85,154 例（中位数为每个研究员 227 例）。工作组提出了新的标准，从五个定义类别（包括前肠、减重手术、腹股沟疝、腹壁疝和实体器官/结肠/胸部）的最低病例量开始。研究员预计将再进行 75 例任何类别的复杂微创外科病例，总共需要完成 150 例。该提案还包括最低数量的柔性内镜（50 例）和提交微创前肠病例进行视频评估。新的标准更明确地定义了在各个类别中哪些外科医生的角色可以获得主要学分。有 14 个住院医师培训计划自愿为 2017-2018 学年试行这些新标准。
新的 SAGES 高级胃肠道/微创外科住院医师培训课程旨在更好地定义这些住院医师培训中应包含的核心内容，同时仍然允许足够的异质性，以便个体学习者可以根据自己的兴趣领域定制培训。这些标准还引入了评估能力的创新、基于证据的方法。在试点计划的结果公布后，SAGES 将考虑广泛实施新的住院医师培训标准。
