照我说的做，而不是照我做的做：外科重症监护项目主任和专科医师塑造未来。

Do as I say and not as I do: Surgical critical care program directors and diplomates shape the future.

作者信息

Jones Tyler J, Barry Carol L, Davis Kimberly A, Martin Niels D, Prendergast Caroline O, Duncan Thomas K, Hildreth Amy N, Inaba Kenji, Jensen Aaron R, Jones Andrew T, Moran Steven L, Palmieri Tina L, Stassen Nicole A, Kaups Krista L, Stein Deborah M

机构信息

From the Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (T.J.J., K.A.D.), Yale School of Medicine, New Haven, Connecticut; Psychometrics and Research (C.L.B., C.O.P.), American Board of Surgery, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery (N.D.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Trauma (T.K.D.), Ventura County Medical Center, Ventura, Virginia; Department of Surgery (A.N.H.), Prisma Health, Columbia, South Carolina; Division of Trauma and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Division of Pediatric Surgery, Department of Surgery (A.R.J.), University of California San Francisco, San Francisco, California; Quality, Research, and Assessment (A.T.J.), American Board of Surgery, Philadelphia, Pennsylvania; Division of Plastic Surgery, Department of Surgery (S.L.M.), Mayo Clinic College of Medicine, Rochester, Minnesota; Burn Division, Department of Surgery (T.L.P.), University of California Davis; Division of Acute Care Surgery, Department of Surgery (N.A.S.), University of Rochester, Rochester, New York; Division of Critical Care Surgery, Department of Surgery (K.L.K.), University of California San Francisco Fresno, Fresno, California; and Division of Critical Care and Trauma, Department of Surgery (D.M.S.), University of Maryland School of Medicine, Baltimore, Maryland.

出版信息

J Trauma Acute Care Surg. 2025 Jun 19. doi: 10.1097/TA.0000000000004615.

DOI:10.1097/TA.0000000000004615

PMID:40536472

Abstract

BACKGROUND

In 1987, the Trauma, Burn, Surgical Critical Care Specialty Board of the American Board of Surgery began offering certification in surgical critical care (SCC). The blueprint for the certifying examination (CE) has changed little since then. The Trauma, Burn, Surgical Critical Care Specialty Board sought to modernize the content of the CE. A draft blueprint was vetted with SCC program directors (PDs) and diplomates to determine how frequently the proposed topics should be tested and how frequently these topics were encountered in clinical practice. The purpose of the study was to evaluate the importance placed on blueprint topics by SCC educators and practitioners, and their relevance to clinical practice.

METHODS

Surgical critical care PDs and diplomates separately reviewed the blueprint and assessed the frequency topics should appear on the CE (4, annually; 3, biennially; 2, every few years; 1, never). Diplomates were also asked how frequently they encountered each topic in practice (4, daily; 3, weekly to monthly; 2, a few times/year; 1, never). Results were compared with t tests, and Cohen's d was calculated. A p value of <0.001 and a moderate effect size (d > 0.50) were used for significance.

RESULTS

Response rates were 42% (n = 70) for PDs and 30% (n = 1307) for diplomates. A total of 188 topics were evaluated. Program directors requested more frequent assessment than diplomates in 28 categories (d's ranged from -0.51 to -0.87) with obstetrical emergencies and intensive care unit billing and coding being the most discordant. For 17 topics, diplomates expressed high discordance between the importance for testing and their current practice.

CONCLUSION

Surgical critical care practice has evolved significantly over the past 35 years. Modernization of the assessments used to measure knowledge should be aligned with practice but requires a balance of topics that are infrequently encountered but are exquisitely time-sensitive and life-threatening.

LEVEL OF EVIDENCE

Survey Study; Level IV.

摘要

背景

1987年，美国外科委员会创伤、烧伤、外科重症监护专科委员会开始提供外科重症监护（SCC）认证。自那时以来，认证考试（CE）的蓝图变化不大。创伤、烧伤、外科重症监护专科委员会试图使CE的内容现代化。一份蓝图草案经过了SCC项目主任（PDs）和专科医师的审核，以确定拟议主题应多久进行一次测试，以及这些主题在临床实践中出现的频率。该研究的目的是评估SCC教育工作者和从业者对蓝图主题的重视程度，以及它们与临床实践的相关性。

方法

外科重症监护PDs和专科医师分别审查了蓝图，并评估了主题应在CE中出现的频率（4，每年一次；3，每两年一次；2，每隔几年一次；1，从不）。专科医师还被问及他们在实践中遇到每个主题的频率（4，每天一次；3，每周至每月一次；2，每年几次；1，从不）。结果用t检验进行比较，并计算科恩d值。显著性水平设定为p值<0.001和中等效应大小（d>0.50）。

结果

PDs的回复率为42%（n = 70），专科医师的回复率为30%（n = 1307）。共评估了188个主题。在28个类别中，项目主任要求的评估频率高于专科医师（d值范围为-0.51至-0.87），产科紧急情况以及重症监护病房计费和编码方面的差异最大。对于17个主题，专科医师表示测试重要性与他们当前实践之间存在高度差异。