Center for Comprehensive Cardiovascular Care, Saint Louis University, Saint Louis, Mo.
Center for Comprehensive Cardiovascular Care, Saint Louis University, Saint Louis, Mo.
J Thorac Cardiovasc Surg. 2019 May;157(5):1925-1932. doi: 10.1016/j.jtcvs.2018.08.124. Epub 2018 Nov 14.
In cardiothoracic surgery, little data exist on the transition to operative independence. We aimed to compare current perceptions of operative autonomy of junior cardiothoracic surgeons and senior colleagues who oversee transitional years.
An anonymous online survey was sent to currently practicing North American board-certified/eligible cardiothoracic surgeons to assess reported time to operative independence and comfort with cardiothoracic operations. The χ2 test, Fisher exact test, and Mann-Whitney U test were used to compare junior surgeons' self-reported experience to the junior experience as reported by the midcareer and senior surgeons with whom they practiced. Logistic regression was performed to assess factors associated with operative independence.
Responses from 436 completed surveys were analyzed (82 juniors and 354 midcareer/seniors). Two hundred fifty-four midcareer/senior surgeons reported on the experience of 531 junior partners. Juniors reported high immediate posttraining comfort with basic cardiac cases and moderate comfort with all other categories. Time to operative independence was significantly different between juniors' self-report and midcareer/senior reports of junior partners except for complex thoracic cases. In multivariable logistic regression analysis, senior, and not midcareer, surgeon status was independently associated with junior operative independence status for cardiac cases and for basic thoracic cases.
Most junior surgeons perceived operative independence with basic thoracic, basic cardiac, and complex cardiac operations earlier in their surgical career than that reported by senior colleagues. Objective measures of operative independence may clarify this discrepancy. This study establishes a baseline by which to compare the effects of integrated 6-year programs on operative independence. The discrepant perceptions may have implications for how training programs prepare graduates for the transition to independent practice.
在心胸外科领域，关于向手术独立性过渡的相关数据很少。我们旨在比较初级心胸外科医生和监督过渡阶段的资深同事对手术自主性的当前看法。
我们向目前在北美的心胸外科委员会认证/合格的心胸外科医生发送了匿名在线调查，以评估他们报告的达到手术独立性的时间和对心胸外科手术的舒适度。使用 χ2 检验、Fisher 确切检验和 Mann-Whitney U 检验来比较初级外科医生的自我报告经验与他们的中级和高级同事所报告的初级经验。使用逻辑回归来评估与手术独立性相关的因素。
分析了 436 份完成调查的回复（82 名初级医生和 354 名中级/高级医生）。254 名中级/高级外科医生报告了 531 名初级合作伙伴的经验。初级医生在接受培训后立即对基本心脏病例的操作非常有信心，对所有其他类别的手术有中等程度的信心。初级医生的自我报告与中级/高级医生报告的初级医生达到手术独立性的时间存在显著差异，除了复杂的胸部病例。在多变量逻辑回归分析中，高级外科医生而不是中级外科医生的身份与初级医生在心脏病例和基本胸部病例中的手术独立性状态独立相关。
大多数初级医生认为他们在手术职业生涯的早期就具有进行基本的胸科、基本的心脏手术和复杂的心脏手术的手术独立性，这与高级同事的报告不同。手术独立性的客观衡量标准可能会澄清这种差异。这项研究为比较 6 年综合计划对手术独立性的影响建立了一个基准。这种不同的看法可能会对培训计划如何为毕业生过渡到独立实践做准备产生影响。
