From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Engels, Rice, Nenshi, Maraccio).
Can J Surg. 2021 May 20;64(3):E298-E306. doi: 10.1503/cjs.019619.
The acute care surgery (ACS) model has been shown to improve patient, hospital and surgeon-specific outcomes. To date, however, little has been published on its impact on residency training. Our study compared the emergency general surgery (EGS) operative experiences of residents assigned to ACS versus elective surgical rotations.
Resident-reported EGS case logs were prospectively collected over a 9-month period across 3 teaching hospitals. Descriptive statistics were tabulated and group comparisons were made using χ2 statistics for categorical data and t tests for continuous data.
Overall, 1061 cases were reported. Resident participation exceeded 90%). Appendiceal and biliary disease accounted for 49.7% of EGS cases. Residents on ACS rotations reported participating in twice as many EGS cases per block as residents on elective rotations (12.64 v. 6.30 cases, p < 0.01). Most cases occurred after hours while residents were on call rather than during daytime ACS hours (78.8% v. 21.1%, p < 0.01). Senior residents were more likely than junior residents to report having a primary operator role (71.3% v. 32.0%, p < 0.01). Although the timing of cases made no difference in the operative role of senior residents, junior residents assumed the primary operator role more often during the daytime than after hours (50.0% v. 33.1%, p = 0.01).
Despite implementation of the ACS model, residents in our program obtained most of their EGS operative experience after hours while on call. Although further research is needed, our study suggests that improved daytime access to the operating room may represent an opportunity to improve the quantity and quality of the EGS operative experience at our academic network.
急性护理外科（ACS）模式已被证明可以改善患者、医院和外科医生的特定结果。然而，迄今为止，关于其对住院医师培训的影响的研究甚少。我们的研究比较了分配到 ACS 与选择性手术轮转的住院医师的急诊普通外科（EGS）手术经验。
在 3 家教学医院进行了为期 9 个月的前瞻性收集住院医师报告的 EGS 手术日志。对描述性统计数据进行了制表，并使用 χ2 统计量进行分类数据比较，使用 t 检验进行连续数据比较。
总体上报告了 1061 例病例。住院医师的参与率超过 90%。阑尾和胆道疾病占 EGS 病例的 49.7%。ACS 轮转的住院医师报告每块 EGS 病例比选择性轮转的住院医师多两倍（12.64 例比 6.30 例，p < 0.01）。大多数病例发生在值班住院医师值班期间，而不是在白天 ACS 时间（78.8%比 21.1%，p < 0.01）。与初级住院医师相比，高级住院医师更有可能担任主要手术医生（71.3%比 32.0%，p < 0.01）。尽管病例的时间对高级住院医师的手术角色没有影响，但初级住院医师在白天比值班时更经常担任主要手术医生（50.0%比 33.1%，p = 0.01）。
尽管实施了 ACS 模式，但我们的项目中的住院医师在值班期间获得了他们的大部分 EGS 手术经验。尽管需要进一步研究，但我们的研究表明，改善白天进入手术室的机会可能代表着改善我们学术网络中 EGS 手术经验的数量和质量的机会。
