Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia.
Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia.
J Surg Educ. 2018 Nov;75(6):1558-1565. doi: 10.1016/j.jsurg.2018.04.001. Epub 2018 Apr 16.
The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement.
A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention.
Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12.
Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated.
普通外科的研究生医学教育认证委员会里程碑项目为培养和跟踪住院医生的能力提供了一种更强大的方法。 该框架增强了住院医生在手术质量改进方面的系统和渐进式能力发展。
一项为期 22 个月的互动式教育计划，基于住院医生特定的手术结果数据，最终为四年级外科住院医生完成了一个质量改进项目。 在干预前后比较了自我评估、质量知识测试和住院医生特定的美国外科医师学会国家外科质量改进计划质量培训计划发病率。
尽管住院医生完成了更复杂的病例，但质量培训计划发病率从 25%（82/325）降至 18%（93/517），p=0.015。 所有参与者都在普通外科里程碑式改善护理、基于实践的学习和改进能力方面达到了 4/4 的能力水平。 机构性美国外科医师学会国家外科质量改进计划普通外科发病率从第九位提高到第六位。 干预后质量评估和改进自我评估评分（M=23.80，SD=4.97）与干预前评分（M=19.20，SD=5.26）相比没有显著提高，p=0.061。 质量改进知识应用工具测试后得分（M=17.4，SD=4.88）与测试前得分（M=13.2，SD=1.92）相比没有显著提高，p=0.12。
与参与者分享经过验证的住院医生特定的临床数据与手术结果的改善有关。 参与四年级外科住院医生在实践中学习和改进能力的最高得分达到了 4 级，在护理实践领域的改进中，他们的得分最高，并且观察到他们参与的病例手术发病率显著降低。
