Granite Guinevere, Pugh Kristy, Chen Hegang, Longinaker Nyaradzo, Garofalo Evan, Shackelford Stacy, Shalin Valerie, Puche Adam, Pasley Jason, Sarani Babak, Henry Sharon, Bowyer Mark, Mackenzie Colin
Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201.
Department of Anatomy and Neurobiology, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201.
Mil Med. 2018 Mar 1;183(suppl_1):66-72. doi: 10.1093/milmed/usx151.
Surgical residents express confidence in performing specific vascular exposures before training, but such self-reported confidence did not correlate with co-located evaluator ratings. This study reports residents' self-confidence evaluated before and after Advanced Surgical Skills for Exposure in Trauma (ASSET) cadaver-based training, and 12-18 mo later. We hypothesize that residents will better judge their own skill after ASSET than before when compared with evaluator ratings.
Forty PGY2-7 surgical residents performed four procedures: axillary artery (AA), brachial artery (BA), femoral artery exposure and control (FA), and lower extremity fasciotomy (FAS) at the three evaluations. Using 5-point Likert scales, surgeons self-assessed their confidence in anatomical understanding and procedure performance after each procedure and evaluators rated each surgeon accordingly.
For all the three evaluations, residents consistently rated their anatomical understanding (p < 0.04) and surgical performance (p < 0.03) higher than evaluators for both FA and FAS. Residents rated their anatomical understanding and surgical performance higher (p < 0.005) than evaluators for BA after training and up to 18 mo later. Only for third AA evaluation were there no rating differences.
Residents overrate their anatomical understanding and performance abilities for BA, FA, and FAS even after performing the procedures and being debriefed three times in 18 mo.
外科住院医师在培训前对进行特定血管暴露手术表现出信心，但这种自我报告的信心与现场评估者的评分并不相关。本研究报告了住院医师在基于尸体的创伤暴露高级外科技能（ASSET）培训前后以及12 - 18个月后的自信心情况。我们假设与评估者评分相比，住院医师在接受ASSET培训后比培训前能更好地判断自己的技能。
40名PGY2 - 7级外科住院医师在三次评估中进行四项手术：腋动脉（AA）、肱动脉（BA）、股动脉暴露与控制（FA）以及下肢筋膜切开术（FAS）。外科医生使用5点李克特量表在每次手术后自我评估他们对解剖学理解和手术操作的信心，评估者据此对每位外科医生进行评分。
在所有三次评估中，对于FA和FAS，住院医师对自己解剖学理解（p < 0.04）和手术操作（p < 0.03）的评分一直高于评估者。培训后直至18个月，住院医师对BA的解剖学理解和手术操作评分高于评估者（p < 0.005）。只有第三次AA评估时没有评分差异。
即使在进行了手术并在18个月内进行了三次汇报后，住院医师对BA、FA和FAS手术的解剖学理解和操作能力仍高估了自己的水平。
