Departments of General Surgery, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, MI.
Departments of General Surgery, Ascension Providence Hospital / Michigan State University College of Human Medicine, Southfield, MI; Victor Valley Global Medical Center, Victorville, CA.
J Am Coll Surg. 2020 Jul;231(1):172-178. doi: 10.1016/j.jamcollsurg.2020.04.036. Epub 2020 May 11.
Teaching assistant (TA) cases are a training mainstay, due to increased resident autonomy. Since 2014, the American Board of Surgery (ABS) requires a 25 TA case minimum for graduating resident eligibility for board certification. Herein, we analyze our institution's experience compared with the national average, for any change effected by the requirement.
ACGME case log data were obtained for the July 2001 to June 2018 academic years. We compared average TA cases of our program against the national average and national 50th percentile: 2001 to 2014, and 2014 to 2018 academic years. The program TA cases were also broken down by category, with a comparison before and after 2014. Values of p were calculated using a t-test and Mann-Whitney U test.
From July 2001 to June 2018, our program averaged 30.1 TA cases/resident, and national 50th percentile average was 28.1. For July 2001 to June 2014 AY (aka pre-2014) and July 2014 to June 2018 AY (aka post-2014) cases per resident, our program averages were 24.9 and 46.1, respectively, and the national 50th percentile averages were 24.4 and 40.3, respectively-both statistically significant increases. Average program percentiles were 46.4 (pre-2014), and 61.5 (post-2014), and 59.6% of program cases logged were biliary, large intestine, and hernia (2001 to 2018 AY), with a statistically significant increase in several case subcategories post-2014.
Teaching assistant cases are an invaluable resource for residents, fostering increased autonomy. Since the 2014 minimum, a statistically significant increase in TA cases was noted in our program and nationally. The majority of sub-categories logged were core procedures. Unequivocally, the TA case minimum requirement has made a difference. This will hopefully lead to increased autonomy and therefore, more comfortable and capable general surgeons. Wide variability is noted in what counts as a TA case, with further clarification needed by the ACGME and ABS.
由于住院医师自主性的提高，助教病例（TA）是培训的主要内容。自 2014 年以来，美国外科学委员会（ABS）要求毕业住院医师获得 25 个 TA 病例，才有资格获得委员会认证。在此，我们分析了本机构与全国平均水平的经验对比，以了解该要求带来的任何变化。
我们获取了 2001 年 7 月至 2018 年 6 月的 ACGME 病例记录数据。将我们项目的平均 TA 病例与全国平均水平和全国 50%分位数进行比较：2001 年至 2014 年，以及 2014 年至 2018 学年。还按类别细分了项目 TA 病例，并比较了 2014 年前后的情况。使用 t 检验和曼-惠特尼 U 检验计算 p 值。
从 2001 年 7 月至 2018 年 6 月，我们项目的平均每个住院医师有 30.1 个 TA 病例，全国 50%分位数的平均水平为 28.1。对于 2001 年 7 月至 2014 年 6 月（即前 2014 年）和 2014 年 7 月至 2018 年 6 月（即后 2014 年）的住院医师病例，我们项目的平均值分别为 24.9 和 46.1，而全国 50%分位数的平均值分别为 24.4 和 40.3，均呈统计学显著增加。项目平均百分位数分别为 46.4（前 2014 年）和 61.5（后 2014 年），并且项目记录的病例中 59.6%是胆道、大肠和疝（2001 年至 2018 年），后 2014 年的几个病例亚类呈统计学显著增加。
助教病例是住院医师的宝贵资源，有助于提高自主性。自 2014 年最低要求以来，我们项目和全国的 TA 病例数量均呈统计学显著增加。记录的大多数亚类都是核心程序。毫无疑问，助教病例最低要求产生了影响。这有望导致自主性的提高，从而使普外科医生更加舒适和胜任。助教病例的计数存在很大差异，ACGME 和 ABS 需要进一步澄清。
