使用智能手机技术追踪耳鼻喉科培训中的手术自主性和表现：一项单机构试点研究。
Tracking operative autonomy and performance in otolaryngology training using smartphone technology: A single institution pilot study.
作者信息
Chen Jenny X, Kozin Elliott, Bohnen Jordan, George Brian, Deschler Daniel, Emerick Kevin, Gray Stacey T
机构信息
Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear/Harvard Medical School Boston Massachusetts.
Department of General Surgery Massachusetts General Hospital Boston Massachusetts.
出版信息
Laryngoscope Investig Otolaryngol. 2019 Nov 11;4(6):578-586. doi: 10.1002/lio2.323. eCollection 2019 Dec.
BACKGROUND
In the era of duty hour restrictions, otolaryngology residents may not gain the operative experience necessary to function autonomously by the end of training. This study quantifies residents' autonomy during key indicator cases, defined by the Accreditation Council for Graduate Medical Education.
STUDY DESIGN
Prospective cohort study.
METHODS
Faculty and residents at a large academic institution were surveyed on the surgical autonomy trainees should achieve for otolaryngology key indicator surgeries at each training level. Residents and faculty used the mobile application "System for Improving and Measuring Procedural Learning" (SIMPL) between December 2017 and July 2018 to log trainees' operative autonomy during cases on a validated four-level Zwisch scale, from "show and tell" to "supervision only."
RESULTS
The study included 40 participants (23 residents and 17 attendings). The survey response rate was 83%. In surveys, residents overestimated the autonomy PGY5 residents should achieve for parotidectomy, rhinoplasty, thyroid/parathyroidectomy, and airway procedures compared with faculty ( < .05). Using SIMPL, 833 evaluations were logged of which 253 were paired evaluations for key indicator cases. Comparing survey predictions with actual cases logged in SIMPL, residents and faculty overestimated the autonomy achieved by senior trainees performing mastoidectomy (PGY5, < .05) and ethmoidectomy (PGY4/5, < .05); both felt that senior residents should operate with between "passive help" and "supervision only" whereas residents actually had "passive help." Residents overestimated their autonomy during rhinoplasty (PGY5, = .017) and parotidectomy (PGY5, = .007) while attendings accurately expected chief residents to have "passive help."
CONCLUSIONS
Resident surgical autonomy varies across otolaryngology procedures. Multicenter studies are needed to elucidate national trends.
LEVEL OF EVIDENCE
背景
在工作时间受限的时代，耳鼻喉科住院医师在培训结束时可能无法获得自主开展手术所需的经验。本研究对住院医师在毕业后医学教育认证委员会定义的关键指标病例中的自主性进行了量化。
研究设计
前瞻性队列研究。
方法
对一家大型学术机构的教员和住院医师进行了调查，了解每个培训阶段耳鼻喉科关键指标手术中住院医师应达到的手术自主性。2017年12月至2018年7月期间，住院医师和教员使用移动应用程序“程序学习改进与测量系统”（SIMPL），根据经过验证的四级Zwisch量表（从“演示与讲解”到“仅监督”）记录住院医师在手术过程中的操作自主性。
结果
该研究纳入了40名参与者（23名住院医师和17名主治医生）。调查回复率为83%。在调查中，与教员相比，住院医师高估了PGY5住院医师在腮腺切除术、隆鼻术、甲状腺/甲状旁腺切除术和气道手术中应达到的自主性（P<0.05）。使用SIMPL记录了833次评估，其中253次是关键指标病例的配对评估。将调查预测结果与SIMPL中记录的实际病例进行比较，住院医师和教员高估了进行乳突切除术的高年级住院医师（PGY5，P<0.05）和筛窦切除术的住院医师（PGY4/5，P<0.05）所达到的自主性；双方都认为高年级住院医师应在“被动帮助”和“仅监督”之间进行操作，而实际上住院医师得到的是“被动帮助”。住院医师高估了他们在隆鼻术（PGY5，P = 0.017）和腮腺切除术（PGY5，P = 0.007）中的自主性，而主治医生准确地预期住院总医师会得到“被动帮助”。
结论
耳鼻喉科手术中住院医师的手术自主性因手术不同而有所差异。需要进行多中心研究以阐明全国趋势。
证据水平
2级。
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