Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Surgery, Howard University Hospital, Washington, DC.
Surgery. 2021 Nov;170(5):1347-1352. doi: 10.1016/j.surg.2021.03.062. Epub 2021 May 8.
Surgical training has undergone many facets of restructuring over the most recent decades, with critiques of the quality and variability of training as well as the competency of recent graduates. This study examines the changes in surgical training in operative volume and breadth in the past 2 decades.
The Accreditation Council for Graduate Medical Education Case Log Statistics Reports from 1999 to 2019 were reviewed. Case logs were grouped into defined case categories and group levels of postgraduate training. Descriptive analyses and multiple linear regressions were performed.
General surgery residents are graduating with 10.7% more cases, owing to increases in mostly junior year cases (P < .001). The breadth of specialty cases has decreased, while there was an increase in alimentary and abdominal cases to 58.4% from 47.2% 20 years ago. A decrease in vascular surgery cases from 19.9% to 10.7% of all cases was noted. Analysis of the distribution of defined categories showed right skewness in many categories with mode being much lower than reported mean.
Evaluation of trends, despite residents graduating with higher case volume than the minimum required, shows that the breadth and variety of cases has narrowed significantly in the past 20 years, providing a case for general surgery training restructuring.
在最近几十年，外科培训经历了许多方面的改革，其培训质量和多样性以及最近毕业生的能力受到了批评。本研究考察了过去 20 年手术培训在手术量和广度方面的变化。
回顾了 1999 年至 2019 年的研究生医学教育认证委员会病例日志统计报告。病例日志被分为定义明确的病例类别和研究生培训的组级。进行了描述性分析和多元线性回归。
由于主要是三年级病例的增加，普通外科住院医师的毕业病例增加了 10.7%（P <.001）。专业病例的广度有所下降，而消化和腹部病例从 20 年前的 47.2%增加到 58.4%。所有病例中血管外科病例从 19.9%下降到 10.7%。对定义类别分布的分析表明，许多类别的分布呈右偏态，众数远低于报告的平均值。
尽管住院医师的毕业病例量高于最低要求，但评估趋势表明，在过去 20 年中，病例的广度和种类明显缩小，这为普通外科培训改革提供了依据。
