Woeste Matthew R, Salyer Christen E, Hammaker Austin C, Dodwad Shah-Jahan, Foote Darci C, Nahmias Jeffry T, Callahan Zachary M, Quillin Ralph C, Cortez Alexander R
From the Department of Surgery, University of Louisville, Louisville, KY (Woeste).
Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, OH (Salyer, Hammaker, Quillin, Cortez).
J Am Coll Surg. 2022 Nov 1;235(5):799-808. doi: 10.1097/XCS.0000000000000311. Epub 2022 Oct 17.
Single-center data suggest that general surgery residents perform more cases related to their future fellowship compared with their peers. This study aimed to determine whether this experience was true for residents across multiple programs.
Data from graduates of 18 Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery residency programs in the US Resident OPerative Experience (ROPE) Consortium were analyzed. Residents were categorized as entering 1 of 12 fellowships or entering directly into general surgery practice. Case log operative domains were mapped to each fellowship, and analyses were performed between groups.
Of 1,192 graduated general surgery residents, 955 (80%) pursued fellowship training whereas 235 (20%) went directly into general surgery practice. The top 3 fellowships pursued were trauma/surgical critical care (18%), vascular surgery (13%), and minimally invasive surgery (12%). Residents entering minimally invasive surgery performed the most total cases, whereas residents pursuing breast performed the least (1,209 [1,056-1,325] vs 1,091 [1,006-1,171], p < 0.01). For each fellowship type, graduates completed more total fellowship-specific cases in their future specialty compared with their peers (all p < 0.05). This association was observed for all 12 fellowships at the surgeon chief level (all p < 0.05) and for 10 of 12 fellowships at the surgeon junior level (all p < 0.05).
General surgery residents perform more cases related to their future specialty choice compared with their peers. These data suggest that the specialization process begins during residency. This tendency among residents should be considered as general surgery residency undergoes structural redesign in the future.
单中心数据表明，与同龄人相比，普通外科住院医师进行的与其未来专科 fellowship 相关的病例更多。本研究旨在确定这种情况在多个项目的住院医师中是否属实。
分析了美国住院医师手术经验（ROPE）联盟中 18 个经研究生医学教育认证委员会（ACGME）认证的普通外科住院医师项目毕业生的数据。住院医师被分为进入 12 个专科 fellowship 之一或直接进入普通外科临床工作。将病例记录手术领域映射到每个专科 fellowship，并在组间进行分析。
在 1192 名毕业的普通外科住院医师中，955 名（80%）接受专科 fellowship 培训，而 235 名（20%）直接进入普通外科临床工作。最热门的 3 个专科 fellowship 是创伤/外科重症监护（18%）、血管外科（13%）和微创手术（12%）。进入微创手术专科 fellowship 的住院医师进行的总病例数最多，而从事乳腺专科的住院医师进行的病例数最少（1209[1056 - 1325]对 1091[1006 - 1171]，p < 0.01）。对于每种专科 fellowship 类型，毕业生在其未来专业中完成的特定专科 fellowship 病例总数比同龄人更多（所有 p < 0.05）。在外科主任级别，所有 12 个专科 fellowship 均观察到这种关联（所有 p < 0.05），在外科初级级别，12 个专科 fellowship 中的 10 个也观察到这种关联（所有 p < 0.05）。
与同龄人相比，普通外科住院医师进行的与其未来专业选择相关的病例更多。这些数据表明专科化过程在住院医师培训期间就开始了。在未来普通外科住院医师培训进行结构重新设计时，应考虑住院医师的这种倾向。
