Braza Matthew E, Adams Nicholas S, Ford Ronald D
Spectrum Health/Michigan State University College of Human Medicine Plastic Surgery Residency, Grand Rapids, Mich.
Elite Plastic Surgery, Grand Rapids, Mich.
Plast Reconstr Surg Glob Open. 2020 Oct 22;8(10):e3163. doi: 10.1097/GOX.0000000000003163. eCollection 2020 Oct.
Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical-legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy.
Anonymous electronic surveys were sent to attending surgeons and residents of all Accreditation Council for Graduate Medical Education accredited programs during the 2017-2018 academic year. Seventy-two integrated and 42 independent plastic surgery programs were surveyed. Analysis of responses was performed using the Fisher exact and chi-square tests.
There were 158 attending surgeon and 129 resident responses. The resident and attending surgeon response rates were 11.7% and 16.8%, respectively. Eighty-seven percent of residents felt their operative experience within residency prepared them for practice. Residents felt least prepared in aesthetics and pediatrics/craniofacial surgery. Attending surgeons perceived that they provided residents graduated autonomy throughout residency. Residents identified the complexity of a procedure, attending surgeon supervision, and time constraints as the largest factors influencing resident autonomy. Attending surgeons noted patient safety as the largest deterrent to autonomy.
In our study, a majority of plastic surgery residents were found to feel prepared for practice after residency; however, preparedness gaps within training still exist in aesthetic and craniomaxillofacial surgery. Plastic surgery programs must work to develop training programs that simultaneously promote resident autonomy, while prioritizing patient safety, and maintaining productivity and financial well-being.
培养合格的外科住院医师需要在培训期间逐步实现独立。最近在其他外科亚专业的研究表明，由于住院医师培训规定的变化、医疗法律问题和经济激励措施，住院医师获得独立的机会总体上减少了。进行了一项调查研究，以评估整形手术住院医师培训期间的自主感和准备情况，并评估影响自主性的因素。
在2017 - 2018学年，向所有经研究生医学教育认证委员会认证项目的主治外科医生和住院医师发送了匿名电子调查问卷。对72个综合整形手术项目和42个独立整形手术项目进行了调查。使用Fisher精确检验和卡方检验对回复进行分析。
收到158名主治外科医生和129名住院医师的回复。住院医师和主治外科医生的回复率分别为11.7%和16.8%。87%的住院医师认为他们在住院医师培训期间的手术经验使他们为执业做好了准备。住院医师在美容整形和儿科/颅面外科方面感觉准备最不足。主治外科医生认为他们在整个住院医师培训期间为住院医师提供了逐渐增加的自主权。住院医师认为手术的复杂性、主治外科医生的监督和时间限制是影响住院医师自主权的最大因素。主治外科医生指出患者安全是自主权的最大阻碍。
在我们的研究中，发现大多数整形手术住院医师在完成住院医师培训后感觉为执业做好了准备；然而，在美容整形和颅颌面外科的培训中仍然存在准备不足的差距。整形手术项目必须努力制定培训计划，在促进住院医师自主权的同时，优先考虑患者安全，并维持生产力和财务状况。
