Department of Surgery; University of Alberta; Edmonton; Alberta; Canada.
Department of Surgery; University of Manitoba; Winnipeg; Manitoba; Canada.
J Surg Educ. 2024 Dec;81(12):103274. doi: 10.1016/j.jsurg.2024.08.024. Epub 2024 Oct 7.
There is concern that current surgical residents are suboptimally prepared for autonomous practice. This qualitative study aimed to clarify perceptions of competency, autonomy and surgical training goals by Canadian cardiac surgery programs and trainees.
This was a qualitative study using semistructured interviews. These were audio recorded and transcribed verbatim. We used thematic analysis and content analysis to deductively analyze interview transcripts. From this, we identified major themes describing competency, autonomy, and goals of surgical training.
All interviews were conducted online over Zoom.
We interviewed 16 individuals (7 trainees and 9 program directors) from 10 Canadian cardiac surgery training programs.
Both trainees and staff agreed that the goal of surgical residency is to produce competent, not autonomous, surgeons. When defining competency, both faculty and trainees identified the importance of technical skills and nontechnical skills, such as surgical decision-making. Both groups believed autonomy and competency to be different, wherein autonomy assumes competency and is distinguished by the ability to make decisions independently. Importantly, 81% (n=13) believed that nontechnical skills were more important for independent practice than technical skills. Only 57% (n=4) of trainees and 33% (n=3) of staff surgeons felt that the current RCPSC competencies were reasonable to achieve during residency training.
We have identified several important discrepancies in the perceptions of competency, autonomy, and surgical training goals. The RCPSC (Royal College of Physicians and Surgeons of Canada) stated goal of producing trainees who are ready for independent practice is discordant with the perspective of Canadian cardiac surgery programs. Many staff and trainees do not feel that the currently espoused competencies are feasible to achieve by graduation. The results of our study will allow us to identify the barriers during training to produce trainees ready for independent practice.
目前人们担心外科住院医师的自主实践准备不足。本定性研究旨在阐明加拿大心脏外科项目和学员对能力、自主性和外科培训目标的看法。
这是一项使用半结构式访谈的定性研究。这些访谈被录音并逐字转录。我们使用主题分析和内容分析对访谈记录进行演绎分析。在此基础上，我们确定了描述能力、自主性和外科培训目标的主要主题。
所有访谈均通过 Zoom 在线进行。
我们采访了来自加拿大 10 个心脏外科培训项目的 16 人（7 名学员和 9 名项目主任）。
学员和工作人员都认为，外科住院医师培训的目标是培养有能力但非自主的外科医生。在定义能力时，教师和学员都认为技术技能和非技术技能（如手术决策）很重要。两组人员都认为自主性和能力不同，其中自主性假设能力，并以独立决策的能力为特征。重要的是，81%（n=13）的人认为非技术技能对于独立实践比技术技能更为重要。只有 57%（n=4）的学员和 33%（n=3）的外科住院医师认为目前的加拿大皇家外科医学院（RCPSC）能力在住院医师培训期间是合理的。
我们发现了对能力、自主性和外科培训目标的看法存在一些重要差异。RCPSC（加拿大皇家内科医师和外科医师学院）制定的培养准备好独立实践的学员的目标与加拿大心脏外科项目的观点不一致。许多工作人员和学员认为目前所倡导的能力在毕业时是难以实现的。我们研究的结果将使我们能够确定培训期间产生准备好独立实践的学员的障碍。
