Diffley Michael, Hall Jamie M D, Tepper Donna, Siddiqui Aamir
Department of General Surgery, Henry Ford Health, Detroit, MI, USA.
Division of Plastic Surgery, Henry Ford Health, Detroit, MI, USA.
Adv Med Educ Pract. 2024 Oct 22;15:999-1004. doi: 10.2147/AMEP.S482437. eCollection 2024.
With increasing specialization among surgical divisions, a well-rounded education during a surgical residency is often accomplished by rotating among different subspecialties. Inclusion of specific rotations in the resident curriculum can be considered as a cost-benefit calculation balancing the value of exposure to a subspecialty versus the opportunity cost of potential learning from another rotation. We find that often these decisions are based on anecdotal feedback. Our goal is to supplement these reports with a quantifiable metric of learning achieved on the plastic surgery rotation. Our hypothesis in this prospective study was that residents would demonstrate improved performance on a post-rotation test after their 1-month rotation on plastic surgery compared to the pre-rotation test.
A question bank was developed to reflect institutional curriculum objectives and clinical scenarios commonly seen on the service. The questions were developed, validated and vetted in collaboration with medical educators and attending plastic surgeons yielding 20 questions available for use. Postgraduate year 1 residents were given a 10-question test before and after their plastic surgery rotation. A one-tailed paired -test was used to assess improvement between the pre-rotation test and the post-rotation test.
A total of 378 tests were administered with 228 (60%) pre- and post-rotation tests completed meeting inclusion criteria. Average percentage of correct answers for the pre-rotation test was 29% and 88% for the post-rotation test showing a differential improvement of 58% (p < 0.001).
Surgical trainee time is a limited commodity. Each clinical rotation needs proven consistent benefit for the trainees. We developed a questionnaire that documents the improvement in clinical knowledge after a one-month rotation on plastic surgery relative to before. The test results were consistent even when comparing trainees who did the rotation early versus late in the PGY-1 year. Clinical exposure reinforces and solidifies specialty learning.
随着外科各科室专业化程度的提高，外科住院医师培训期间全面的教育通常通过在不同亚专业间轮转来完成。在住院医师课程中纳入特定轮转可被视为一种成本效益计算，需权衡接触某一亚专业的价值与从另一轮转中潜在学习的机会成本。我们发现，这些决策往往基于轶事性反馈。我们的目标是用整形外科轮转学习的可量化指标来补充这些报告。在这项前瞻性研究中，我们的假设是，与轮转前测试相比，住院医师在进行1个月的整形外科轮转后，在轮转后测试中的表现会有所提高。
开发了一个题库，以反映机构课程目标和该科室常见的临床场景。这些问题是与医学教育工作者和整形外科主治医生合作开发、验证和审核的，最终有20个问题可供使用。一年级住院医师在整形外科轮转前后分别进行一次10道题的测试。采用单尾配对t检验评估轮转前测试和轮转后测试之间的进步情况。
共进行了378次测试，其中228次（60%）轮转前和轮转后测试完成并符合纳入标准。轮转前测试的平均正确答案百分比为29%，轮转后测试为88%，显示出58%的差异进步（p<0.001）。
外科实习生的时间是有限的资源。每次临床轮转都需要为实习生带来经证实的持续益处。我们开发了一份问卷，记录了在整形外科轮转1个月后相对于之前临床知识的进步。即使比较在PGY - 1年早期和晚期进行轮转的实习生，测试结果也是一致的。临床接触强化并巩固了专业学习。
