Department of Continuing Education, University of Oxford Oxford UK.
General Surgery Directorate Sheffield Teaching Hospitals NHS Trust Sheffield UK.
BJS Open. 2018 Dec 24;3(2):218-223. doi: 10.1002/bjs5.50122. eCollection 2019 Apr.
Task-sharing in surgery is well established, with associate clinicians performing successful surgery in many countries. Little is known about the process of surgical skill acquisition by associate clinicians, or whether this differs from that of doctors.
A blinded experimental study compared surgical skill acquisition by Sierra Leonean associate clinicians enrolled in an essential and emergency surgery training programme with that of a matched group of UK surgical trainees. After identical instruction, practice time and with identities disguised, trainees were videoed performing simulated surgery. Trainees were marked on 12 performance parameters and five behaviour characteristics using validated tools and qualitative comment.
The Sierra Leonean group comprised 19 associate clinicians and one doctor; the UK group comprised 20 doctors in their first 5 years of training. The UK group had significantly more surgical and postgraduate experience than the Sierra Leonean group. The Sierra Leonean trainees outperformed the UK trainees on three of the 12 performance parameters and four of the five behaviour characteristics. UK trainees did not outperform Sierra Leonean trainees on any parameter or characteristic. Qualitative differences in learning style were observed.
Sierra Leonean associate clinicians demonstrated equal or superior skill in all objective parameters tested, despite having less experience than the UK doctors.
手术中的任务分担在许多国家已经得到了很好的建立，副临床医生在成功进行手术方面发挥了重要作用。然而，对于副临床医生获得手术技能的过程，以及这是否与医生有所不同，我们知之甚少。
一项盲法实验研究比较了塞拉利昂参加基本和紧急手术培训计划的副临床医生与一组英国外科培训生的手术技能习得情况。在接受相同的指导、练习时间并掩盖身份后，培训生被拍摄了模拟手术的视频。使用经过验证的工具和定性评论，对培训生的 12 项绩效参数和 5 项行为特征进行了标记。
塞拉利昂组由 19 名副临床医生和 1 名医生组成；英国组由 20 名在培训的头 5 年的医生组成。英国组的手术和研究生经验明显多于塞拉利昂组。塞拉利昂培训生在 12 项绩效参数中的 3 项和 5 项行为特征中的 4 项上的表现优于英国培训生。英国培训生在任何参数或特征上都没有超过塞拉利昂培训生。观察到学习风格的定性差异。
尽管塞拉利昂副临床医生的经验少于英国医生，但他们在所有经过测试的客观参数中都表现出同等或更高的技能。
