Shih Jessica G, Quong Whitney L, Knox Aaron D C, Zhygan Nick, Courtemanche Douglas J, Brown Mitchell H, Fish Joel S
Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada.
Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.
J Burn Care Res. 2019 Oct 16;40(6):796-804. doi: 10.1093/jbcr/irz086.
With the ongoing implementation of a competency-based medical education (CMBE) model for residency programs in North America, emphasis on the duration of training has been refocused onto ability and competence. This study aims to determine the exposure of burn-related core procedural competencies (CPCs) in Canadian Plastic Surgery Residents in order to enhance curricular development and help define its goals. A retrospective review of burn-related resident case logs encompassing all 10 English-speaking plastic surgery residency programs from 2004 to 2014 was performed, including analysis of personal competence scores and resident role by Postgraduate Year (PGY)-year. Case logs of a total of 55 graduating plastic surgery residents were included in the study. Overall, 4033 procedures in burn and burn-related care were logged, accounting for 6.8% of all procedures logged. On average, each resident logged 73 burn procedures, 99% of which were CPCs. The most frequently performed procedure was harvest and application of autograft, allograft, or xenograft, while emergent procedures such as escharotomy and compartment release were performed on average less than one time per resident. Personal competence scores as well as role of the resident (surgical responsibility) increased as PGY-year progressed during residency. Canadian plastic surgery residency programs provide adequate exposure to the majority of the scope of burn care and surgery. However, infrequently encountered but critical procedures such as escharotomy and fasciotomy may require supplementation through dedicated educational opportunities. CMBE should identify these gaps in learning through facilitation of resident competency evaluation. With consideration for the amount of exposure to burn-related CPCs as identified, plastic surgery residency programs can work toward achieving competency in all aspects of burn care and surgery prior to the completion of residency.
随着北美住院医师培训项目基于能力的医学教育（CMBE）模式的持续实施，对培训时长的关注已重新聚焦于能力和胜任力。本研究旨在确定加拿大整形外科住院医师烧伤相关核心程序能力（CPCs）的接触情况，以加强课程开发并帮助明确其目标。对2004年至2014年涵盖所有10个英语授课整形外科住院医师培训项目的烧伤相关住院医师病例日志进行了回顾性分析，包括按研究生年级（PGY）分析个人能力得分和住院医师角色。共有55名毕业的整形外科住院医师的病例日志纳入研究。总体而言，记录了4033例烧伤及烧伤相关护理程序，占所有记录程序的6.8%。平均而言，每位住院医师记录了73例烧伤程序，其中99%为CPCs。最常进行的程序是自体皮、异体皮或异种皮的切取与应用，而诸如焦痂切开术和筋膜间隔切开术等急诊程序平均每位住院医师进行少于1次。在住院医师培训期间，随着PGY年级的推进，个人能力得分以及住院医师的角色（手术职责）均有所增加。加拿大整形外科住院医师培训项目为大多数烧伤护理和手术范围提供了充足的接触机会。然而，诸如焦痂切开术和筋膜切开术等不常遇到但关键的程序可能需要通过专门的教育机会进行补充。CMBE应通过促进住院医师能力评估来识别这些学习差距。考虑到已确定的烧伤相关CPCs的接触量，整形外科住院医师培训项目可努力在住院医师培训结束前实现烧伤护理和手术各方面的能力。
