Mittal Monica, Supramaniam Prasanna Raj, Lim Lee Nai, Hamoda Haitham, Savvas Mike, Narvekar Nitish
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, UK.
GMS J Med Educ. 2019 Feb 15;36(1):Doc7. doi: 10.3205/zma001215. eCollection 2019.
To compare the cumulative pregnancy rate (CPR) for experienced clinicians and trainees naive to the skill of embryo transfer (ET) during an assisted reproductive treatment (ART) cycle. To establish the minimum number of procedures required to achieve consistent outcomes. A non-interventional retrospective observational cohort study looking at all consecutive ETs undertaken over a 5-year study period. The CPR was determined by a self-reported urinary home pregnancy test undertaken 16 days after oocyte retrieval. The CPR did not differ between an experienced clinician (39%) and trainee (45%) for the first 50 (p=0.41) and last 50 (40.7% versus 42.7%) (p=0.81) ET procedures. The CPR for the individuals remained consistent with their peaks and troughs mirroring the overall success rate of the unit. This pattern continued when the data was further stratified for co-variables (age [≤37 years of age], catheter type [soft] and embryo quality [expanded blastocyst of grade ≥2]): CPRs for experienced clinicians was 65.7% (first 50 transfers) and 40.9% (last 50 transfers); CPR for trainees was 66.7% (first 50 transfers) and 53.6% (last 50 transfers); p=0.95 and p=0.37, respectively. The trainees, however, were more likely to use a stylet catheter with a 2-step transfer technique, with a cost over clinical implication. Furthermore, patients expressed a preference for an experienced clinician to perform their procedure, despite being informed that the grade of the clinician had no impact on the cycle outcome after an analysis of the unit's data. The clinician's grade and duration of service have not been shown to significantly impact the outcome of the ART cycle. The findings, however, should be interpreted with caution, as they reflect the culture of training in the unit, where there is a strong emphasis on adequate direct and indirect supervision. Furthermore, the relationship between the volume of work and outcomes is established in postgraduate medical education, with the exact number required to achieve clinical competence being dependent on the procedure and intensity of the workload.
比较辅助生殖治疗（ART）周期中经验丰富的临床医生与初次接触胚胎移植（ET）技术的实习生的累积妊娠率（CPR）。确定实现一致结果所需的最少程序数量。一项非干预性回顾性观察队列研究，观察了在5年研究期间进行的所有连续ET。CPR通过卵母细胞采集后16天进行的自我报告尿妊娠试验确定。在前50例（p=0.41）和后50例（40.7%对42.7%）（p=0.81）ET程序中，经验丰富的临床医生（39%）和实习生（45%）的CPR没有差异。个体的CPR与其峰值和谷值保持一致，反映了该单位的总体成功率。当根据协变量（年龄[≤37岁]、导管类型[软质]和胚胎质量[≥2级扩张囊胚]）进一步分层数据时，这种模式仍在继续：经验丰富的临床医生的CPR为65.7%（前50次移植）和40.9%（后50次移植）；实习生的CPR为66.7%（前50次移植）和53.6%（后50次移植）；p分别为0.95和0.37。然而，实习生更有可能使用带有两步移植技术的探针导管，这在成本上超过了临床意义。此外，尽管在分析该单位数据后告知患者临床医生的级别对周期结果没有影响，但患者仍表示更倾向于由经验丰富的临床医生进行手术。临床医生的级别和服务年限尚未显示对ART周期的结果有显著影响。然而，这些发现应谨慎解释，因为它们反映了该单位的培训文化，其中非常强调充分的直接和间接监督。此外，研究生医学教育中已确立了工作量与结果之间的关系，实现临床能力所需的确切数量取决于程序和工作量强度。
