Dept. of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA, USA.
Dept. of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA, USA.
Am J Surg. 2019 May;217(5):918-922. doi: 10.1016/j.amjsurg.2019.01.012. Epub 2019 Jan 26.
Surgical training has traditionally relied on increasing levels of resident autonomy. We sought to analyze the outcomes of senior resident teaching assist (TA) cases performed with a structured policy including varying levels of staff supervision.
Retrospective review at a military medical center of TA cases from 2009 to 2014. The level of staff supervision included staff scrubbed (SS), staff present and not scrubbed (SP), or staff not present but available (NP). Operative variables were analyzed. An anonymous survey of residents and attendings at 6 military programs regarding experience and opinions on TA cases was distributed.
389 TA cases were identified. The majority (52%) were performed as NP. Operative times were shorter for NP cases (p < 0.05). Overall complication rate and length of stay were not different between groups (p > 0.05). Survey results demonstrated agreement amongst staff and residents that allowing selective NP was critical for achieving resident competence.
There were no identified adverse effects on intraoperative or postoperative complications. This practice is a critical component of training senior residents to transition to independent practice.
外科培训传统上依赖于住院医师自主权的提高。我们旨在分析在包括不同程度的工作人员监督的结构化政策下，由高级住院医师助教（TA）进行的病例的结果。
在一家军队医疗中心对 2009 年至 2014 年的 TA 病例进行回顾性分析。工作人员监督的程度包括工作人员洗手（SS）、工作人员在场但未洗手（SP）或工作人员不在场但可提供帮助（NP）。分析了手术变量。向 6 个军事项目的住院医师和主治医生分发了一份关于 TA 病例经验和意见的匿名调查。
确定了 389 例 TA 病例。大多数（52%）是 NP 病例。NP 病例的手术时间更短（p<0.05）。各组之间的总体并发症发生率和住院时间没有差异（p>0.05）。调查结果表明，工作人员和住院医师一致认为允许选择性 NP 对于培养住院医师的能力至关重要。
术中或术后并发症没有发现不良影响。这种做法是培训高级住院医师过渡到独立实践的重要组成部分。
