Toale Conor, O'Byrne Aisling, Morris Marie, Kavanagh Dara O
Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
Surgery. 2022 Nov;172(5):1364-1372. doi: 10.1016/j.surg.2022.07.015. Epub 2022 Aug 26.
The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence.
A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model.
Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b).
Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.
手术学习曲线是一种可观察和测量的现象。手术经验目标已被确立为衡量各司法管辖区外科培训中手术能力的替代指标。本研究的目的是对有关外科培训中的手术经验与学员能力之间关系的现有证据进行批判性分析。
根据系统评价和Meta分析的首选项目指南，对PubMed、Embase、科学网和Cochrane图书馆数据库进行系统评价。检索定义外科培训中的手术量与学员能力、熟练程度或掌握程度之间关系的文章。使用改良的柯克帕特里克模型评估纳入研究的教育影响。
在数据库检索中识别出的3672条记录中，最终纳入30篇论文。14项研究使用手术时间作为能力的替代指标来定义手术经验阈值，另有8项研究使用培训师对手术表现的评估（柯克帕特里克第3级）。另外5项研究能够确定学员病例数与随后患者结局之间的关系（柯克帕特里克第4b级）。
许多研究记录了学员在关键指标手术中达到超过各司法管辖区目前规定目标的经验阈值后，表现出胜任能力。缺乏将当前手术经验目标与一系列外科亚专业的患者结局相关联的证据。本综述支持在外科培训中朝着基于标准的手术表现目标参考方向发展。
