Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2022 Aug;167(2):268-273. doi: 10.1177/01945998211050350. Epub 2021 Oct 5.
There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents' surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education.
Prospective study.
Five otolaryngology training programs.
Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale.
Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level ( < .001). Resident self-assessments of autonomy and performance were lower than paired attending assessments ( < .001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%).
In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals.
目前人们担心耳鼻喉科住院医师可能没有接受足够的外科培训。我们旨在描述 5 个学术中心的住院医师在执行由研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education）概述的 14 项关键指标程序（Key Indicator Procedures，KIPs）方面的手术经验。
前瞻性研究。
耳鼻喉科培训计划的 5 个。
数据是从 2019 年 12 月至 2020 年 12 月使用来自改善医学专业学习协会的智能手机应用程序收集的。在每次手术后，住院医师和教员都会根据 4 级 Zwisch 量表评估学员的自主性，并根据 5 级改良 Dreyfus 量表评估表现。
住院医师和主治医生（分别为 92 人和 78 人）记录了 2984 次评估。主治医生对住院医师自主性和表现的评估随着培训水平的提高而提高（ < .001）。住院医师对自主性和表现的自我评估低于配对主治医生的评估（ < .001）。在主治医生对高年级住院医师（第 4 或 5 年住院医师）进行的 KIP 评估中，55%的病例是在有意义的自主下进行的（仅提供被动帮助或监督）。同样，主治医生认为 55%的这些病例表现出准备实践或卓越的表现。大多数 KIP 中，高年级住院医师的病例有意义的自主性超过 50%，除了皮瓣和移植物（40%）、儿科/成人气道（39%）和镫骨切除术/听骨成形术（33%）。同样，除了儿科/成人气道（42%）和镫骨切除术/听骨成形术（33%）之外，高年级住院医师在所有 KIP 中获得准备实践或卓越表现的比例超过 50%。
在这项多中心研究中，住院医师的外科自主性和表现因耳鼻喉科 KIP 而异。建立全国性的基准将有助于计划和住院医师设定教育目标。
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