Durbin C G, McLafferty C L
Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville 22908.
Anesth Analg. 1993 Sep;77(3):418-26. doi: 10.1213/00000539-199309000-00002.
The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and training in CCM. All 38 anesthesiology programs having accredited CCM fellowships were surveyed. Four of these and one program without CCM fellowships were used to develop the survey instrument. Four programs without CCM fellowships and 34 programs with CCM fellowships make up the survey group. Returned were 640 surveys from 37 (97%) programs accounting for over 30% of the possible residents. Resident interest in pursuing CCM training decreased as year of residency increased (P < 0.0001). Residents in programs with little patient care responsibility during intensive care unit (ICU) rotations expressed less interest in CCM training (P < 0.012). The administrative role of the anesthesiology department in the ICU also influenced resident interest (P < 0.014). Written responses to open-ended questions suggested resident concerns with the following: stress of chronic care, financial consequences of additional year of training, ICU call frequency and load, ICU role ambiguity, and shared decision-making in the ICU. A recurring question was, "Are there jobs (outside of academics) for anesthesiologist intensivists?" Most residents knew a CCM anesthesiologist they admired and knew that there were unfilled fellowship positions available. Defining the job market, improving curriculum and teaching, supporting deferment of student loans, and introducing residents and medical students to the ICU earlier may increase the interest in CCM practice among anesthesiology residents.
近年来，追求重症医学（CCM）专科培训的麻醉学住院医师数量一直在减少。每年都有大量培训岗位空缺。通过调查住院医师对CCM实践和培训的态度，评估了导致这种下降的可能原因。对所有38个拥有经认可的CCM专科培训项目的麻醉学项目进行了调查。其中4个项目和1个没有CCM专科培训项目被用于开发调查问卷。4个没有CCM专科培训项目和34个有CCM专科培训项目组成了调查群体。共收到来自37个（97%）项目的640份调查问卷，占可能参与调查的住院医师的30%以上。随着住院年限的增加，住院医师追求CCM培训的兴趣降低（P<0.0001）。在重症监护病房（ICU）轮转期间承担较少患者护理责任的项目中的住院医师对CCM培训的兴趣较低（P<0.012）。麻醉学系在ICU中的管理角色也影响了住院医师的兴趣（P<0.014）。对开放式问题的书面回答表明住院医师关注以下方面：长期护理的压力、额外一年培训的经济后果、ICU值班频率和工作量、ICU角色的模糊性以及ICU中的共同决策。一个反复出现的问题是：“麻醉重症医师（学术界以外）有工作机会吗？”大多数住院医师都认识一位他们钦佩的CCM麻醉医师，并且知道有未填补的专科培训岗位。明确就业市场、改进课程和教学、支持推迟学生贷款以及更早地让住院医师和医学生接触ICU，可能会增加麻醉学住院医师对CCM实践的兴趣。
