Banerjee A R, Reilly P G, Marshall J N, Nunez D
Dept of Otolaryngology/Head and Neck Surgery, Leicester Royal Infirmary.
Ann R Coll Surg Engl. 1996 May;78(3 Suppl):119-21.
The working patterns of clinical postgraduate trainees are being scrutinised in preparation for the implementation of new, structured and shortened postgraduate specialist training programmes. Current practice in the National Health Service dictates, in all branches of surgery, the evaluation of elective admissions undergoing procedures under general anaesthetic by a junior trainee (SHO or HO) who then arranges the appropriate preoperative investigations. This doctor acts as a "generalist' in that he is primarily concerned with the patient's general fitness for the operation as well as with the specific condition to be treated. The anaesthetist also evaluates the patient prior to the operation. In his case his sole concern is to whether or not the patient is fit for a general anaesthetic. This prospective study investigated the extent of duplication in preoperative elective patient assessment by both the otolaryngology trainee and the anaesthetist in order to answer the question: are both assessments necessary? The medical records of 100 consecutive adult elective admissions to the Leicester Royal Infirmary Otolaryngology Department which provides inpatient services to a catchment population of 900,000 were reviewed. The case histories obtained by clinicians blind to the study were classified as positive or negative for relevant features. The case histories obtained by the otolaryngology trainee and anaesthetist showed a level of disagreement which was 9 per cent greater than chance. It appears that there is a low level of duplication in preoperative elective otolaryngology patient assessment and both otolaryngology trainee and anaesthetic examination are of value.
为准备实施新的、结构化且缩短的研究生专科培训计划，临床研究生培训生的工作模式正受到审查。英国国家医疗服务体系（National Health Service）目前的做法规定，在所有外科分支中，由初级培训生（住院医师或实习医生）对接受全身麻醉手术的择期入院患者进行评估，然后安排适当的术前检查。这位医生扮演着“多面手”的角色，因为他主要关注患者的整体手术适应性以及待治疗的具体病情。麻醉师也在手术前对患者进行评估。在他的评估中，他唯一关心的是患者是否适合全身麻醉。这项前瞻性研究调查了耳鼻喉科培训生和麻醉师在术前择期患者评估中的重复程度，以回答这个问题：两种评估都有必要吗？对莱斯特皇家医院耳鼻喉科连续100例成年择期入院患者的病历进行了审查，该科室为90万人口提供住院服务。对不了解该研究的临床医生获取的病史，根据相关特征分为阳性或阴性。耳鼻喉科培训生和麻醉师获取的病史显示出的分歧程度比随机情况高9%。术前择期耳鼻喉科患者评估中的重复程度似乎较低，耳鼻喉科培训生和麻醉师的检查都有价值。
