Jordan Rebecca M, Ullrich Lauryn A, Decapua-Guarino Alexandria, Klock Brian
195466 Department of General Surgery, Geisinger Wyoming Valley, Wilkes Barre, PA, USA.
Am Surg. 2020 Sep;86(9):1119-1123. doi: 10.1177/0003134820943551. Epub 2020 Aug 17.
The Accreditation Council for Graduate Medical Education (ACGME) provides no specific guidelines for surgical critical care (SCC) training during general surgery residency. Growing emphasis is placed on this experience with increasing case requirements and dedicated SCC content on board certification exams.
A digital survey was distributed to ACGME-accredited general surgery residencies via email. Respondents reported number and setting of critical care months during residency and rated comfort level within 5 critical care principles and overall satisfaction with their SCC experience. Study cohorts were formed to compare experiences and competencies between respondents based on setting, months, postgraduate year (PGY) level, and formal surgical intensive care unit (SICU) experience. Differences between cohorts were compared using the Mantel-Haenszel test ( < .05).
Seventy-three residents responded with 45% training at academic centers versus 46% in community hospitals. Approximately 50% completed a formal SICU rotation, while 9% reported no dedicated critical care rotation during residency. Overall, 78% felt satisfied with their SCC experience. Residents training at academic centers were more satisfied overall and felt more comfortable with ventilator management. Those who completed 5 or more months of critical care training reported greater confidence with intravenous sedation and ventilator management, while residents having a formal SICU rotation felt more confident with vasopressor and ventilator management.
Variability remains within SCC training among general surgery residents with perceived benefits seen in training at academic centers and completing a formal SICU rotation. Although limited, these findings offer a foundation for developing an effective SCC curriculum.
毕业后医学教育认证委员会（ACGME）未针对普通外科住院医师培训期间的外科重症监护（SCC）培训提供具体指导方针。随着病例要求的增加以及委员会认证考试中专门的SCC内容，对这一经验的重视程度日益提高。
通过电子邮件向ACGME认证的普通外科住院医师项目发放了一份数字调查问卷。受访者报告了住院期间重症监护月数及地点，并对5项重症监护原则的舒适度以及对其SCC经验的总体满意度进行了评分。根据培训地点、月数、研究生年级（PGY）水平和正规外科重症监护病房（SICU）经验，组成研究队列以比较受访者之间的经验和能力。使用Mantel-Haenszel检验比较队列之间的差异（<.05）。
73名住院医师做出回应，其中45%在学术中心接受培训，46%在社区医院接受培训。约50%完成了正规的SICU轮转，而9%报告在住院期间没有专门的重症监护轮转。总体而言，78%对其SCC经验感到满意。在学术中心接受培训的住院医师总体上更满意，并且对呼吸机管理更有信心。完成5个月或更长时间重症监护培训的人对静脉镇静和呼吸机管理更有信心，而有正规SICU轮转的住院医师对血管活性药物和呼吸机管理更有信心。
普通外科住院医师的SCC培训仍存在差异，在学术中心培训和完成正规SICU轮转可带来明显益处。尽管有限，但这些发现为制定有效的SCC课程提供了基础。
