Bucher Joshua T, Bryczkowski Christopher, Wei Grant, Riggs Renee L, Kotwal Anoop, Sumner Brian, McCoy Jonathan V
Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Pl. MEB Rm. 104, New Brunswick, NJ, 08903, USA.
Jersey Shore University Medical Center, Neptune City, NJ, USA.
Int J Emerg Med. 2018 Feb 14;11(1):7. doi: 10.1186/s12245-018-0167-x.
The purpose of our study is to investigate rates of individual procedures performed by residents in our emergency medicine (EM) residency program. Different programs expose residents to different training environments. Our hypothesis is that ultrasound examinations are the most commonly performed procedure in our residency.
The study took place in an academic level I trauma center with multiple residency and fellowship programs including surgery, surgical critical care, trauma, medicine, pulmonary/critical care, anesthesiology and others. Also, the hospital provides a large emergency medical services program providing basic and advanced life support and critical care transport, which is capable of performing rapid sequence intubation. Each EM residency class, except for the first 2 months of the inaugural class, used New Innovations to log procedures. New Innovations is an online database for tracking residency requirements, such as procedures and hours. For the first 3 months, procedures were logged by hand on a log sheet. In addition, our department has a wireless electronic system (Qpath) for recording and logging ultrasound images. These logs were reviewed retrospectively without any patient identifiers. Actual procedures and simulation procedures were combined for analysis as they were only logged separately halfway through the study period. Procedures were summed and the average procedure rate per resident per year was calculated.
In total, 66 full resident years were analyzed. Overall, ultrasound was the most commonly performed procedure, with each resident performing 125 ultrasounds per year. Removing "resuscitations," the second most common was endotracheal intubation, performed 28.91 times per year, and third most was laceration repair, which was performed 17.39 times per year. Our lowest performed procedure was thoracentesis, which was performed on average 0.11 times per resident per year.
Residents performed a variety of procedures each year. Ultrasound examinations were the most frequent procedure performed. The number of ultrasound procedures performed may reflect the changing training landscape and influence future Accreditation Council of Graduate Medical Education requirements.
我们研究的目的是调查我们急诊医学（EM）住院医师培训项目中住院医师执行的各项操作的比率。不同的项目会让住院医师接触到不同的培训环境。我们的假设是超声检查是我们住院医师培训中最常执行的操作。
该研究在一所一级学术创伤中心进行，该中心有多个住院医师培训和专科 fellowship 项目，包括外科、外科重症监护、创伤、内科、肺科/重症监护、麻醉学等。此外，该医院提供大型紧急医疗服务项目，提供基础和高级生命支持以及重症监护转运，能够进行快速顺序插管。除了首届班级的前两个月，每个 EM 住院医师班级都使用 New Innovations 记录操作。New Innovations 是一个用于跟踪住院医师要求（如操作和时长）的在线数据库。在最初的 3 个月里，操作是手工记录在日志表上的。此外，我们科室有一个用于记录和存储超声图像的无线电子系统（Qpath）。这些日志在没有任何患者标识符的情况下进行回顾性审查。实际操作和模拟操作在研究期间中途才开始分别记录，因此将它们合并进行分析。对操作进行汇总，并计算每名住院医师每年的平均操作率。
总共分析了 66 个完整的住院医师年。总体而言，超声检查是最常执行的操作，每名住院医师每年进行 125 次超声检查。去除“复苏操作”后，第二常见的是气管插管，每年进行 28.91 次，第三常见的是伤口缝合，每年进行 17.39 次。我们执行最少的操作是胸腔穿刺术，每名住院医师每年平均进行 0.11 次。
住院医师每年执行各种操作。超声检查是最常执行的操作。超声操作的数量可能反映了不断变化的培训情况，并会影响未来研究生医学教育认证委员会的要求。
