University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania.
University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania.
J Surg Educ. 2021 Sep-Oct;78(5):1599-1604. doi: 10.1016/j.jsurg.2020.12.019. Epub 2021 Jan 13.
The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training.
In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and American Hospital Association annual survey data. New-to-practice general surgeons with and without subspecialty board-certification in colorectal surgery (CRS) or cardiothoracic surgery (CTS) were identified in 2008, and followed over 10 years. Surgeon overall inpatient case volume, colorectal resection case volume, and thoracic lobectomy case volume were compared between surgeons with and without related subspecialty training.
NY and FL (2008-2017).
The study population included 276 new-to-practice surgeons with mean age of 36.9 years. New-to-practice surgeons were defined as those with zero to three years of experience in 2008.
Of all surgeons, 11.2% were subspecialty board-certified in CRS and 11.6% were subspecialty board-certified in CTS. Board-certified CRS surgeons performed more colorectal resections than the non-CRS general surgeons each year (p-value <0.001 for all). Overall, non-CRS general surgeons performed 60.7% of all colorectal resections. Board-certified CTS surgeons performed more thoracic lobectomies than non-CTS surgeons each year. Non-CTS surgeons performed 1.1% of all thoracic lobectomies.
On average, new subspecialty surgeons perform significantly more specialty operations than non-subspecialty new general surgeons. However, as a group, new non-colorectal general surgeons perform the majority of colorectal resections. In contrast, new non-cardiothoracic general surgeons perform less than two percent of the thoracic lobectomies. This may have implications for a shift in the training paradigm going forward.
随着 Fellowship 培训和整合住院医师培训的亚专科外科医生的日益集中，他们对所谓的“真正”普外科实践的广度和数量产生了影响，导致新普外科医生的角色发生了变化。我们旨在描述具有和不具有结直肠外科（CRS）或心胸外科（CTS）专业奖学金培训的新普外科医生的手术实践。
在这项回顾性队列研究中，州际出院数据与美国医学协会大师档案和美国医院协会年度调查数据相关联。2008 年确定了具有和不具有结直肠外科（CRS）或心胸外科（CTS）专业委员会认证的新开业普外科医生，并对他们进行了超过 10 年的随访。比较了具有和不具有相关专业培训的外科医生的整体住院患者病例量、结直肠切除术病例量和胸腔镜肺叶切除术病例量。
纽约州和佛罗里达州（2008-2017 年）。
研究人群包括 276 名新开业的外科医生，平均年龄为 36.9 岁。新开业的外科医生被定义为在 2008 年有零至三年经验的外科医生。
所有外科医生中，11.2%的人在 CRS 方面获得专业委员会认证，11.6%的人在 CTS 方面获得专业委员会认证。每年接受专业委员会认证的 CRS 外科医生进行的结直肠切除术多于非 CRS 普外科医生（所有手术的 p 值均<0.001）。总体而言，非 CRS 普外科医生进行了 60.7%的结直肠切除术。接受专业委员会认证的 CTS 外科医生每年进行的胸腔镜肺叶切除术多于非 CTS 外科医生。非 CTS 外科医生进行了 1.1%的胸腔镜肺叶切除术。
平均而言，新的亚专科外科医生进行的专业手术明显多于非亚专科新普外科医生。然而，作为一个整体，新的非结直肠普外科医生进行了大多数结直肠切除术。相比之下，新的非心胸外科医生进行的胸腔镜肺叶切除术不到 2%。这可能对未来的培训模式转变产生影响。
