Mann Tobias R, James Michelle A, Harrast John, Kaplan F Thomas D
Indiana Hand to Shoulder Center, Indianapolis, IN.
Shriners Hospital for Children, Northern California and University of California Davis Health Systems, Sacramento, CA.
J Hand Surg Am. 2019 Oct;44(10):819-828.e17. doi: 10.1016/j.jhsa.2019.07.005. Epub 2019 Aug 24.
To investigate the variety of cases that are performed by newly graduated fellowship-trained orthopedic hand surgeons.
All cases submitted by board-eligible orthopedic surgeons taking part II of their board examination between 2004 and 2013 were obtained from the database of the American Board of Orthopaedic Surgery (ABOS). Each case was then categorized based on the fellowship training of the treating surgeon and whether it was a hand surgery case. Each hand surgery case was then further categorized into 1 of the 8 surgical categories used by the ABOS to determine eligibility for the Subspecialty Certificate in Orthopaedic Surgery of the Hand (SCOSH).
During our study period, 6,854 orthopedic surgeons submitted 858,146 cases to the ABOS. Fellowship-trained hand surgeons made up 13% of all surgeons, and 24% of all submitted cases were hand surgery cases. Based on the cases submitted, 44% of hand surgeons were not on track to become eligible for the SCOSH. The most common reason for not reaching eligibility was failure to meet the minimum requirements in 1 of either the congenital, the skin and wound problems, the contracture and joint stiffness, the microvascular, or the tumor categories.
A large proportion of fellowship-trained orthopedic hand surgeons are not on track to meet the minimum eligibility requirements for the ABOS SCOSH during their part II case collections. Their case profile is not sufficiently diverse to be considered an active hand surgery practice for the purpose of SCOSH eligibility.
This study highlights 1 possible reason why over one-third of young hand surgeons do not obtain their subspecialty certification.
调查新近毕业并接受过专科培训的骨科手外科医生所开展的各类手术病例。
从美国骨科医师协会（ABOS）数据库中获取2004年至2013年间参加骨科医师资格考试第二部分的符合委员会资格要求的骨科医生提交的所有病例。然后根据主治医生的专科培训情况以及该病例是否为手外科病例对每个病例进行分类。接着，将每个手外科病例进一步归类为ABOS用于确定手外科专科证书（SCOSH）资格的8个手术类别中的1类。
在我们的研究期间，6854名骨科医生向ABOS提交了858146例病例。接受过专科培训的手外科医生占所有医生的13%，所有提交病例中的24%为手外科病例。根据提交的病例，44%的手外科医生未有望获得SCOSH资格。未达资格的最常见原因是在先天性疾病、皮肤与伤口问题、挛缩与关节僵硬、微血管疾病或肿瘤类别中的某一类未达到最低要求。
很大一部分接受过专科培训的骨科手外科医生在收集第二部分病例期间未有望达到ABOS SCOSH的最低资格要求。就SCOSH资格而言，他们的病例类型不够多样化，不足以被视为积极的手外科实践。
本研究突出了超过三分之一的年轻手外科医生未获得其专科证书的一个可能原因。
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