Caldwell Katharine E, Wood Elizabeth C, Brunt L Michael, Neff Lucas P, Westcott Carl, Awad Michael M, Kalmeta Shan L, Nikolian Vahagn C, Bosley Maggie E
Washington University of St. Louis School of Medicine, St. Louis, MO, USA.
Wake Forest School of Medicine, Winston-Salem, NC, USA.
Surg Endosc. 2025 Jun;39(6):3648-3653. doi: 10.1007/s00464-025-11733-1. Epub 2025 Apr 28.
With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography.
The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data.
The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01).
Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a "seniorization" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.
随着先进成像技术和内窥镜检查的出现，我们推测术中胆管造影（IOC）在住院医师培训中的应用有所减少且目前不足。为此，我们评估了全国普通外科住院医师进行腹腔镜胆囊切除术（无论是否进行术中胆管造影）的经验。
对2012年至2023年全国毕业后医学教育认证委员会（ACGME）的普通外科住院医师手术记录进行评估。按研究生年级、项目类型（学术型、社区型、混合型、军队型）和住院医师角色（第一助手、初级外科医生、主治外科医生）对完成的腹腔镜胆囊切除术（CCY）数量和进行了胆管造影的CCY数量进行评估和比较。采用方差分析来分析数据。
在2012 - 2013学年和2022 - 2023学年之间，所有胆囊切除术中即将毕业的普通外科住院医师的胆囊切除术病例数有所增加（123.9对143，p < 0.01）。在此期间，进行CCY + IOC的数量显著下降（25.1对21.6，p = 0.02）。大学附属项目进行IOC的数量在统计学上低于社区型项目（19.3对34.1，p < 0.01）、混合型项目（24.0，p < 0.01）或军队型项目（26.3，p < 0.01）。社区型项目进行CCY + IOC的比例高于其他任何组（p < 0.01）。尽管在研究期间CCY + IOC的数量有所下降，但由主治（PGY5）住院医师进行的CCY + IOC的比例却在增加（p < 0.01）。
住院医师进行IOC的经验在下降。住院医师进行IOC的比例和数量的减少与住院医师经验的“资深化”相关。这种变化可能导致未来普通外科医生队伍缺乏足够的IOC经验，并最终影响患者安全。为了增强技术和解读方面的经验，应在培训环境中提倡广泛开展IOC。可能需要进行全国性的IOC评估来解决这一迫在眉睫的不足。
