Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic College of Medicine and Science, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
Department of Surgery, Mayo Clinic, Rochester, MN.
Surgery. 2019 Jun;165(6):1093-1099. doi: 10.1016/j.surg.2019.01.018. Epub 2019 Mar 14.
The transition from fourth-year medical student to surgical intern is difficult. A lack of repetitions, experience, and knowledge is problematic. We report our experience using simulation-based technical and nontechnical skills to assess the competency of surgical interns in July and January of their intern year.
As part of a larger assessment effort, our general surgery interns (2010-2016) have been tested on performing an emergent cricothyrotomy, interpreting 2 arterial blood gases, and reading 3 chest x-rays in fewer than 7 minutes. We retrospectively analyzed general surgery interns' performance on these 3 tests (total score = 20).
A total of 210 interns completed both July and January (identical) assessments. Overall mean scores improved from July (12.62 ± 3.44) to January (16.5 ± 2.46; P < .05). During the study period general surgery interns' mean baseline scores improved in both July (P < .05) and in January (P < .05). Although most individual general surgery interns did improve their total scores (92% improved, 3% same, 5% worse) between July and January (P < .05), in January 40% could not perform an emergent cricothyrotomy swiftly, and 6% missed a tension pneumothorax on chest x-ray.
Our data suggest that surgical interns start residency training with low levels of skill and comprehension with emergent cricothyrotomy, arterial blood gas, and chest x-ray. They improve with 6 months of clinical and simulation training. Encouragingly, overall scores for both July and January assessments have improved during the study period. Given that some interns still struggle in January to perform these three tasks, we believe that 2018 interns are better, but still potentially lack critical knowledge and skill.
从四年级医学生过渡到外科住院医师是困难的。缺乏重复、经验和知识是有问题的。我们报告了使用基于模拟的技术和非技术技能来评估外科住院医师在其住院医师年 7 月和 1 月的能力的经验。
作为更大评估工作的一部分，我们的普通外科住院医师（2010-2016 年）在不到 7 分钟内完成了紧急环甲切开术、解释 2 次动脉血气和阅读 3 次胸部 X 光片的测试。我们回顾性分析了普通外科住院医师在这 3 项测试中的表现（总分为 20 分）。
共有 210 名住院医师完成了 7 月和 1 月（相同）的评估。总体平均分数从 7 月的 12.62 ± 3.44 提高到 1 月的 16.5 ± 2.46（P <.05）。在研究期间，普通外科住院医师的平均基线分数在 7 月（P <.05）和 1 月（P <.05）都有所提高。尽管大多数普通外科住院医师的总分都有所提高（92%提高，3%相同，5%下降）在 7 月至 1 月之间（P <.05），但在 1 月，有 40%的人不能迅速进行紧急环甲切开术，有 6%的人在胸部 X 光片中漏诊张力性气胸。
我们的数据表明，外科住院医师在开始住院医师培训时，在紧急环甲切开术、动脉血气和胸部 X 光方面的技能和理解能力较低。他们在 6 个月的临床和模拟培训中得到了提高。令人鼓舞的是，在研究期间，7 月和 1 月评估的总分都有所提高。鉴于一些住院医师在 1 月仍难以完成这三项任务，我们认为 2018 年的住院医师更好，但仍可能缺乏关键知识和技能。
