Shah Deepa, Haisch Carl E, Noland Seth L
Department of Surgery, East Carolina University, Greenville, North Carolina.
Department of Transplant Surgery, East Carolina University, Greenville, North Carolina.
J Surg Educ. 2018 Mar-Apr;75(2):304-312. doi: 10.1016/j.jsurg.2018.01.007. Epub 2018 Feb 1.
The Accreditation Council for Graduate Medical Education (ACGME) continues to play an integral role in accreditation of surgical programs. The institution of case logs to demonstrate competency of graduating residents is a key component of evaluation. This study compared the number of vascular cases a surgical resident has completed according to the ACGME operative log to their operative proficiency, quality of anastomosis, operative experience, and confidence in both a simulation and operative setting.
General surgery residents ranging from PGY 1 to 5 participated in a simulation laboratory in which they completed an end-to-side vascular anastomosis. Each participant was given a weighted score based on technical proficiency and anastomosis quality using a previously validated Global Rating Scale (Duran et al, 2014). These scores were correlated to the General Surgery Milestones. Participants completed preoperative and postoperative surveys assessing resident operative experience using the 4-level Zwisch scale (DaRosa et al., 2013), confidence with vascular procedures and confidence performing simulated anastomoses. Confidence was assessed on a scale from 1 to 9 (not confident to extremely confident). Case logs were recorded for each participant. An IRB approved questionnaire was distributed to assess preoperative and postoperative roles of both the resident physician and faculty, with a defined goal. Univariate and multivariate analysis was performed.
Twenty-one general surgery residents were evaluated in the simulation laboratory and 8 residents were assessed intraoperatively. The residents were evenly distributed throughout clinical years. Groups of residents were divided into quartiles based upon the number of vascular cases recorded in the ACGME database. No correlation was found between number of cases, Milestones score and the weighted score (p = 0.94). No statistical significance was found between confidence and quality of anastomosis (p = 0.1). Resident operative experience per the Zwisch scale was categorized most commonly as "Smart Help" by both the trainee and attending surgeon, despite mean resident confidence ratings of 6.67 (± 1.61) with vascular procedures.
ACGME case logs, which are utilized to assess readiness for completion of general surgery residency, may not be indicative of a resident's operative competency and technical proficiency. Confidence is not correlated with technical ability. Faculty and resident insight as to their role in a procedure differ, as faculty feel that they are providing less help than the resident perceives. Careful examination of resident operative technique is the best measure of competency.
毕业后医学教育认证委员会（ACGME）在外科住院医师培训项目的认证中持续发挥着不可或缺的作用。使用病例日志来证明住院医师的能力是评估的关键组成部分。本研究根据ACGME手术日志，比较了外科住院医师完成的血管手术病例数量与其手术熟练度、吻合质量、手术经验以及在模拟和手术环境中的信心。
1至5年级的普通外科住院医师参加了模拟实验室，在其中完成了端侧血管吻合。根据技术熟练度和吻合质量，使用先前验证的全球评分量表（杜兰等人，2014年）为每位参与者给出加权分数。这些分数与普通外科里程碑相关。参与者完成了术前和术后调查，使用4级兹维施量表（达罗萨等人，2013年）评估住院医师的手术经验、对血管手术的信心以及进行模拟吻合的信心。信心评估范围为1至9分（从不自信到极度自信）。记录了每位参与者的病例日志。分发了一份经机构审查委员会批准的问卷，以评估住院医师和教员在术前和术后的角色，并设定了明确的目标。进行了单变量和多变量分析。
在模拟实验室中评估了21名普通外科住院医师，术中评估了8名住院医师。住院医师在各临床年级分布均匀。根据ACGME数据库中记录的血管手术病例数量，将住院医师组分为四分位数。未发现病例数量、里程碑分数与加权分数之间存在相关性（p = 0.94）。在信心与吻合质量之间未发现统计学意义（p = 0.1）。尽管住院医师对血管手术的平均信心评分为6.67（±1.61），但根据兹维施量表，住院医师的手术经验在实习医生和主治医生中最常被归类为“明智的帮助”。
用于评估普通外科住院医师培训完成准备情况的ACGME病例日志可能无法表明住院医师的手术能力和技术熟练度。信心与技术能力无关。教员和住院医师对他们在手术中的角色的看法不同，因为教员觉得他们提供的帮助比住院医师认为的要少。仔细检查住院医师的手术技术是能力的最佳衡量标准。
