DiSegna Steven T, Kelley Timothy D, DeMarco Deborah M, Patel Abhay R
Department of Orthopaedics, University of Massachusetts Medical School, Worcester, Massachusetts.
J Surg Orthop Adv. 2018 Spring;27(1):42-46.
It is unclear how the Accreditation Council for Graduate Medical Education (ACGME) resident duty hour restriction has affected attending orthopaedic surgeons in their first year of practice. The purpose of this study was to compare the clinical preparedness of first-year orthopaedic attending surgeons who trained with ACGME duty hour regulations versus those trained without regulations. Senior orthopaedic surgeons with greater than 10 years of experience were surveyed and results indicate that first-year attendings who trained with ACGME duty hour regulations required more supervision reviewing cases preoperatively, required more assistance completing operative cases, had inferior technical skills, had more major operative complications, had poorer physical exam skills, and delivered an inferior quality of care. Private attendings were most critical. In the postregulatory era, residency programs must optimize the resident's time to ensure competency on graduation. Strategies include increasing midlevel staff, focusing on competencies outlined by ACGMEmilestones, and increasing the role of simulation. (Journal of Surgical Orthopaedic Advances 27(1):42-46, 2018).
目前尚不清楚毕业后医学教育认证委员会（ACGME）对住院医师工作时长的限制是如何影响从事骨科手术的外科医生第一年的临床工作的。本研究旨在比较接受ACGME工作时长规定培训的第一年骨科主治医生与未接受该规定培训的医生的临床准备情况。对经验超过10年的资深骨科外科医生进行了调查，结果表明，接受ACGME工作时长规定培训的第一年主治医生在术前病例审查时需要更多监督，完成手术病例时需要更多协助，技术技能较差，主要手术并发症更多，体格检查技能更差，提供的护理质量更低。私人执业的主治医生对此最为不满。在监管后的时代，住院医师培训项目必须优化住院医师的时间，以确保其毕业时具备胜任能力。策略包括增加中级工作人员、关注ACGME里程碑概述的能力以及增加模拟的作用。（《外科骨科进展杂志》27(1):42 - 46, 2018）
