Miles Luke Fitzgerald, Granche Janeway, Hoffman Christopher Ryan, Green Michael Stuart
J Educ Perioper Med. 2020 Oct 1;22(4):E651. doi: 10.46374/volxxii-issue4-hoffman. eCollection 2020 Oct-Dec.
Anesthesia residents are deemed competent based on subjective and objective metrics. Knowledge acquisition and procedural skill is often difficult to accurately measure. Inspecting tangible metrics of perioperative efficiency may provide a source for reliable evaluation.
Retrospective case-log database review yielded 3072 surgical cases involving residents over 5 years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status (ASA PS) classification, and inpatient versus day surgery status.
After controlling for procedure duration time, inpatient status, ASA PS, surgeon, and attending anesthesiologist, resident training time had high statistical significance. In the fully adjusted model, 1 year of resident training was associated with a reduction in emergence time by 28 seconds. A 1-hour increase in procedure time was associated with an increase in emergence time of 34 seconds.
Although a statistically significant correlation between anesthesia resident training time and emergence time was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We caution the value of using perioperative metrics (e.g., emergence time) for evaluating anesthesia resident competency, until such metrics have undergone significant validation.
麻醉住院医师的能力是根据主观和客观指标来判定的。知识获取和操作技能往往难以准确衡量。检查围手术期效率的具体指标可能为可靠评估提供依据。
对病例记录数据库进行回顾性研究，纳入了5年间涉及住院医师的3072例外科手术病例。主要研究变量是手术结束至离开手术室的时间。记录的其他变量包括星期几、麻醉主治医生姓名、外科主治医生姓名、患者年龄、性别、美国麻醉医师协会身体状况（ASA PS）分级以及住院手术与日间手术状态。
在控制了手术时长、住院状态、ASA PS、外科医生和麻醉主治医生等因素后，住院医师培训时间具有高度统计学意义。在完全调整模型中，住院医师培训1年与苏醒时间减少28秒相关。手术时间每增加1小时，苏醒时间增加34秒。
虽然麻醉住院医师培训时间与苏醒时间之间存在统计学上的显著相关性，但鉴于实际节省的时间相对较少，其临床意义可能较低。在这些指标经过充分验证之前，我们提醒使用围手术期指标（如苏醒时间）评估麻醉住院医师能力的价值。
