手术室中的高授权与低授权行为。
High vs. low entrustment behaviors in the operating room.
机构信息
University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USA.
出版信息
Am J Surg. 2021 May;221(5):973-979. doi: 10.1016/j.amjsurg.2020.09.015. Epub 2020 Sep 16.
BACKGROUND
Operative experience with an appropriate degree of supervised autonomy is critical to resident training. Progressively greater intraoperative entrustment has been associated with gradually higher levels of resident autonomy. This study attempts to identify consistently observed intraoperative behaviors that are linked with higher resident entrustment.
METHODS
This qualitative study analyzed observational notes recorded by trained raters who provided entrustment scores for 204 surgical cases at Michigan Medicine from 2015 to 2017. Notes were coded in NVivo12. Thematic analysis was used to identify themes and patterns within the data.
RESULTS
The analysis generated 144 codes. Codes were clustered into 10 themes. These themes manifested differently in intraoperative behaviors strongly associated with high entrustment versus low entrustment.
CONCLUSION
This study demonstrates key differences in intraoperative behaviors exhibited by residents and faculty in high and low entrustment interactions. Awareness of behaviors that enhance entrustment can help faculty augment resident learning and enable higher resident operative autonomy.
背景
适当程度的监督自主权的手术经验对住院医师培训至关重要。随着手术过程中委托权限的逐步增加，住院医师的自主权也逐渐提高。本研究试图确定与更高的住院医师委托权限相关的一致观察到的手术室内行为。
方法
本定性研究分析了从 2015 年到 2017 年密歇根医学中心 204 例手术的训练有素的评估者记录的观察记录，评估者为这些手术提供了委托评分。笔记在 NVivo12 中进行了编码。使用主题分析来确定数据中的主题和模式。
结果
分析生成了 144 个代码。代码被聚类为 10 个主题。这些主题在与高委托和低委托相关的手术室内行为中表现出不同。
结论
本研究表明，在高委托和低委托互动中，住院医师和教员表现出关键的行为差异。了解增强委托权限的行为可以帮助教员提高住院医师的学习能力，并使住院医师具有更高的手术自主权。
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