Rowe M I, Courcoulas A, Reblock K
Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA 15213, USA.
J Pediatr Surg. 1997 Feb;32(2):184-91. doi: 10.1016/s0022-3468(97)90176-7.
There has been a rapid increase in the number of pediatric surgical training programs. To meet the goals of quality patient care and surgical education, training and practice activities must be objectively monitored. The aim of this study was to collect and analyze the experience of American and Canadian Pediatric Surgical training centers and residents. The authors collected the 1-year operative experience of 31 American and six Canadian training programs and the 2-year operative experience of the 25 most recently graduated residents. Categories analyzed included total cases, defined categories (neonatal, important, and tumor cases), routine cases, thoracic, cardiac, urologic reconstructive, head and neck, endoscopy, vascular, plastics and burn procedures. From these data six assumptions about the training in pediatric surgery were addressed. (1) The operative activity of the United States and Canadian training programs and residents are comparable. The results show that there are few major differences in operative experience. (2) There should be variability in operative experience between programs but little variability between residents. The North American operative experience for both residents and institutions are marked by high variability and leftward shift in the frequency distributions. (3) A resident's training should consist of a significant portion of "index cases" and fewer routine cases. The residents perform 28% of their total cases in the three defined categories (index cases) and 26% as routine cases. (4) Pediatric surgeons are the true general surgeons, performing operations in areas such as cardiac, reconstructive genitourinary, plastic, and burn surgery. Examination of the data shows that most programs and residents perform few cases in these four areas. (5) Certain procedures such as thoracic, genitourinary, vascular, head and neck, and endoscopy remain within the domain of pediatric surgery. The results show that this assumption is true for thoracic, vascular, head and neck, and endoscopy but not for genitourinary, and there is wide variability between institutions and between residents. (6) "Core" pediatric surgical conditions such as esophageal atresia, biliary atresia, and intersex are still available in significant numbers to train residents. The data show that a surprising number of programs and residents perform few or none of the core operations. This analysis is the first step toward monitoring of pediatric surgical resident education. A future study is underway to evaluate the current experience of practicing pediatric surgeons who have taken the recertification examination.
儿科外科培训项目的数量迅速增加。为实现优质患者护理和外科教育的目标，必须对培训和实践活动进行客观监测。本研究的目的是收集和分析美国和加拿大儿科外科培训中心及住院医师的经验。作者收集了31个美国和6个加拿大培训项目的1年手术经验以及25名最近毕业的住院医师的2年手术经验。分析的类别包括总病例数、特定类别（新生儿、重要和肿瘤病例）、常规病例、胸科、心脏、泌尿重建、头颈、内镜、血管、整形和烧伤手术。基于这些数据探讨了关于儿科外科培训的六个假设。（1）美国和加拿大培训项目及住院医师的手术活动具有可比性。结果表明，手术经验方面几乎没有重大差异。（2）不同项目之间的手术经验应有差异，但住院医师之间差异应较小。北美住院医师和机构的手术经验在频率分布上具有高度变异性且向左偏移。（3）住院医师培训应包括很大一部分“索引病例”且常规病例较少。住院医师在三个特定类别（索引病例）中完成其总病例数的28%，作为常规病例的占26%。（4）儿科外科医生是真正的普通外科医生，在心脏、泌尿生殖重建、整形和烧伤外科等领域开展手术。对数据的审查表明，大多数项目和住院医师在这四个领域的手术病例很少。（5）某些手术，如胸科、泌尿生殖、血管、头颈和内镜手术仍属于儿科外科范畴。结果表明，对于胸科、血管、头颈和内镜手术，这一假设是正确的，但对于泌尿生殖手术并非如此，且机构之间和住院医师之间存在很大差异。（6）诸如食管闭锁、胆道闭锁和两性畸形等“核心”儿科外科疾病仍有大量病例可供住院医师培训。数据显示，数量惊人的项目和住院医师很少或根本不进行核心手术。该分析是监测儿科外科住院医师教育的第一步。目前正在进行一项未来研究，以评估参加再认证考试的在职儿科外科医生的当前经验。
